After your operation it will take a while for the healing and swelling to reduce before you can begin to eat properly. Immediately post-operatively (once you are sufficiently stable) you can start having sips of water, making sure you drink them slowly. Each patient tolerates different consistencies at different times of their recovery. Gradually increase the consistency of your diet over the next weeks as your body permits. You can build up your diet, progressing to soups and soft foods. Slowly introduce foods of a thicker consistency, but you are advised to always chew your food well, never rush your food and to drink small amounts of fluids with your meals. Eat slowly – wait 1 minute in between each bite. It is better to eat small, frequent meals to help you consume the majority of nutrients you need without causing your stomach to feel full or distended. It takes 30 seconds for the oesophagus to regain its strength after a swallow. If food seems to be hanging up, slow down and wait at least 1 minute between bites. Large bites are likely to have a harder time going down and are more likely to lead to spasm and hiccups. To prevent swallowing air, which produces excess gas, avoid drinking through a straw and don`t chew gum. Sit upright for 30 minutes after each meal. Gravity can help food move through your digestive tract. Do not lie down for 2 hours after your last snack or meal of the day. Some patients become constipated and need laxatives if their bowels have not opened. 

Week 1 

Clear fluids progressing to a soft `sloppy` diet. 

Week 2-3 

Soft `sloppy` diet 

Week 4-5 

Soft diet progressing to a normal diet. 

Week 6 

Normal diet (as agreed with your consultant) 

Foods to avoid:

• Carbonated beverages
• Crusty bread
• Tough meats
• Raw vegetables 
• Very hot/cold fluids. Warm or room temperature liquids tend to be more comfortable than cold. Cold liquids lead to the weakest pressures (meaning more difficult for things to go down). Small sips frequently are helpful to prevent dehydration. 
• Citrus juices 
• Caffeine 
• Alcohol 

Limit food which may cause gas and irritation. 

• Beans 
• Onions 
• Citrus fruits
• Highly spiced and fatty foods 
• Tomatoes and tomato products 

You may take your normal prescription medications. It is sometimes helpful to take them with yogurt or applesauce instead of water. If you are still having problems swallowing them, you can check with your pharmacist and see if you can crush or break them. Hold off on large vitamins or supplements until you are swallowing without difficulty.

Sometimes patients will experience shoulder pain or deep pain in the chest after surgery. This is due in part to the gas used at laparoscopy, but more so to the sutures placed in the diaphragm muscle; and should gradually resolve. Heat applied to the shoulders tends to help this pain the best. It may be difficult/uncomfortable to take a deep breath or lie flat immediately after surgery as breathing uses the diaphragm muscle. This will slowly improve as you heal from surgery. Doing slow deep meditation type breathing will help with recovery.

You will have typically 5 small incisions between your belly button and your rib cage. The incisions can be closed in a number of ways with an absorbable stitch, surgical skin glue or steristrip (paper suture), Generally these will be covered with a water-resistant dressing of some sort. You may shower or bathe, but you should avoid getting the wounds wet for 48 hours. Avoid placing oil lotions on the glue and it will gradually peel off over time. Sometimes a swelling and/or a lump under the incision will develop and is part of the natural healing process; you need not be alarmed unless there is drainage more than a plaster will handle. Bruising may occur here too. Prior to your discharge from hospital the nurses will provide you with wound care instructions on your discharge.

Hiccups are most often due to fluid and/or food that has not passed out of the oesophagus. Typically, they will stop in a few minutes. Wait until the hiccups have passed before resuming oral intake.

Some patients experience spasm (chest tightness that can take your breath away) during the recovery period. Typically, this will last a minute or so. Spasm is most often due to food getting stuck in the lower oesophagus though sometimes will occur spontaneously. Although it can be very uncomfortable, it is not serious, and the frequency and severity will decrease as time goes by. If after 4 weeks you are having spasms every time you eat please make an appointment to see us, or at least contact our office by phone or email to let us know.

Q: What is Nissen Fundoplication?
A: Nissen fundoplication is a surgery used to treat gastroesophageal reflux disease. It involves sewing the stomach in position around the lower oesophagus to create a one-way valve.

Q: How long does surgery take?
A: This surgery is a laparoscopic procedure and usually takes around 60-90 minutes.

Q: What do I need to do after I go home?
A: When you return home:

• You will need to follow our dietary advice.
• Some patients become constipated and need to take laxatives if their bowels have not opened.

Q: When to seek medical attention?
A: You should seek medical attention if you experience any of the following symptoms:

• Difficulty swallowing yoghurt like consistency food for more than 50% of the time.
• Vomiting and not being able to keep fluids down.
• Vomiting or passing blood
• Severe chest or leg pain
• Fever over 38.6

Q: When can I drive?
A: You may drive again when you can perform an emergency stop, but you should check with your insurance company about when you are covered to drive again.

Q: How long do I need off work?
A: You may need two or three weeks off work depending on the nature of your job.

Q: When can I shower or bath?
A: You may bathe or shower as your wounds will be covered with small dressings (some are water resistant and the nursing staff at the hospital will be able to advise you on wound care before you leave hospital), but please avoid getting the wounds wet for approximately 48 hours after surgery. If you notice any signs of infections – high temperature, redness or swelling – please contact Mr Nick Boyle’s Office.

Q: Will I have any scars?
A: You will have four to five small 0.5-1 cm small scars on your abdomen.

Q: When can I start to exercise?
A: You can start non-strenuous activities as soon as you feel up to it after your surgery, but you should not resume lifting or strenuous exercise for at least a month.

Q: Do I need to stay overnight?
A: If you live more than one hour away from the hospital you need to make your own provision to stay locally so that if you need to return in the event of an emergency, you can do so.

Q: Can we contact you in an emergency?
A: We work office-based hours and during these you can contact us either by phone or by email. Outside these hours if it is an emergency, please call the hospital where you had your procedure or attend A and E. If you contact the hospital the RMO on duty or the nursing staff will be able to answer your queries and if clinically required, they can contact your consultant.

Q: Do I need a carer or companion with me for the first 24 hours?
A: It is traditional guidance and practice that following day case surgery patients should be discharged to be with a carer for 24 hours. See British Association of Day Case Surgery guidelines https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14639