Overview

This information explains how you progress with your eating and drinking after surgery to the food pipe and stomach.

You may have surgery to remove:

• all or part of your food pipe (oesophagus) and part of your stomach (an oesophagectomy)
• your whole stomach (a total gastrectomy)

After the surgery, your food pipe takes time to heal and recover. This means that you need to progress with your diet slowly.

Good nutrition is an important part of your recovery. Immediately after your surgery, however, it is best to avoid:

• eating too much (large portion sizes)
• having foods that are difficult to chew or swallow

The information covers:

• when you are fed intravenously through a line into your vein (parenteral nutrition) after your surgery
• when it is time to progress with your diet
• guidance about portion sizes
• following a "little and often" eating approach
• having a reduced or no appetite after surgery
• losing weight
• taking oral nutritional supplements

If you have any questions or concerns, please contact your dietitian.

Parenteral nutrition

During your surgery, we are likely to put a line (called a central venous catheter or CVC) into a vein in your neck. This line can be used to give you nutrition. 

The nutrition (called parenteral nutrition or PN) is in liquid form and goes straight into your bloodstream.

On the day after your surgery, a dietitian sees you. They:

• assess what nutrition you need
• arrange the parenteral nutrition

You stay on parenteral nutrition until you are ready to start a level 6 soft and bite-sized diet. When you can manage the level 6 soft and bite-sized diet, we remove the CVC line.

If there are any delays in how your diet progresses because of a complication, you might need to stay on parenteral nutrition for longer. In this case, we will remove the CVC line in your neck and put a line in your arm (called a peripherally inserted central catheter or PICC). This line is more suited to longer-term use.

In some cases, you might need other types of nutrition. Your surgical team and dietitian will talk to you about this.

When it is time to progress with your diet

Your surgical team guides you on when it is appropriate to progress with your eating and drinking. This happens in stages.

The surgical team reviews you every day and explains when it is safe to progress to the next stage. The stages of progression are as follows:

1. Clear fluids.
2. Free fluids.
3. Level 6 soft and bite-sized diet. You can also continue to have clear and free fluids.

You see a dietitian to talk about eating and drinking after your surgery. Please ask if you have any questions.

When you go home, you need to continue following a level 6 soft and bite-sized diet. Your dietitian gives you more written information about this.

Examples of clear fluids

Examples of clear fluids are:

• still water
• sugar-free squash
• black or herbal tea with no sugar
• black coffee with no sugar

Examples of free fluids

These are smooth liquids or anything that quickly melts in the mouth into liquid form, with no lumps or pieces.

Examples of free fluids are:

• milk
• juice
• tea or coffee with milk, sugar or both
• milkshake
• hot chocolate
• smooth soup
• smooth yoghurt
• ice cream
• jelly
• thin custard
• mousse
• oral nutritional supplements

Level 6 soft and bite-sized diet

A level 6 soft and bite-sized diet is made up of food that is:

• soft, tender and moist (slightly wet)
• easily mashed into small pieces using a fork

Suitable breakfast options include:

• porridge
• Ready Brek®
• cornflakes, Rice Krispies® or bran flakes (all softened with milk)

For lunch and dinner, there is a separate level 6 soft and bite-sized menu. Please ask the food service assistant for this when they come to take your meal orders. 

You are served a standard portion size, but should aim to eat half of this.

Your dietitian gives you information on a level 6 soft and bite-sized diet before your surgery. You can talk to them about what foods and portion sizes are suitable.

You need to continue this diet until you see the surgical team at your outpatient follow-up appointment. They guide you on when you can progress to normal textures.

Portion sizes

After your surgery, you cannot manage the same meal portions as you did before. This is because your stomach is smaller or has been completely removed.

We recommend having about half of your previous portions. You may be able to increase your portion sizes with time. However, we would not recommend having more than two-thirds of your previous portion sizes.

Little and often eating approach

As your portion sizes at meals are smaller, this dramatically reduces the amount of nutrients that you eat and drink. 

For this reason, we recommend that you take a "little and often" approach to eating. This involves having 3 snacks a day, in addition to your meals. Each day, we encourage you to have:

• breakfast
• a mid-morning snack
• lunch
• a mid-afternoon snack
• dinner
• an evening snack

Your appetite

After your surgery, it is normal to have a reduced or no appetite. This may improve with time, but your appetite is unlikely to return in the same way that it was before the surgery.

It is important that you follow a little and often meal pattern. Do not rely on hunger as a trigger for when to eat.

Losing weight

It is normal to lose weight after your surgery but you need to try to minimise this. 

Too much weight loss:

• slows down your recovery
• can affect your wellbeing

Following a little and often meal pattern is important in helping you to maintain your weight.

Oral nutritional supplements

Oral nutritional supplements are products available on prescription. Your dietitian may recommend that you take them in addition to your diet.

The supplements give you extra nutrients that you need after surgery. They are available as:

• drinks
• soups
• gels
• desserts

Your dietitian guides you on:

• whether you need oral nutritional supplements
• which ones to take
• how much to take

Your dietitian also makes sure that you have a supply of any recommended supplements to take home.