Before Surgery: Prior to surgery, most patients will be placed on a liquid diet for 7-10 days. This diet helps deplete the glycogen stores in the liver, making the liver shrink and become less fragile. This is helpful in surgery as we have to lift up the left side of the liver in order to reach the diaphragm and esophagus. We will have you stop aspirin a week before and anti-inflammatories such as advil, aleve, Naprosyn, 48 hours prior to sugery. Please stop herbal supplements and any marijuana use 2 weeks before surgery. Unless your surgery is later in the afternoon, we have patients have nothing to eat or drink after midnight the night before. For the most part, you may continue all of your medications that you normally take, even the morning of surgery with a sip of water. Please let the office know if you are taking any medication that thins the blood (Coumadin, Plavix, etc). The hospital and anesthesia will try to contact you prior to surgery. We will have you arrive to the hospital 2 hours prior to your surgery.
After Surgery: Surgery itself takes around 2 hours. You will be in the recovery room for at least an hour. At that point, if your pain is controlled and you are feeling ok, you can be discharged. If pain control is an issue, or Dr Bell has any concerns, then you will stay overnight. You can start drinking liquids as soon as you wake up from the anesthesia. You will be sent home with a prescription for narcotic pain medication and nausea medication just in case you have nausea after the surgery.
Pain: Most patients have pain up into the shoulders, usually the left shoulder. This can go up into the neck or behind the shoulder blades. This is from the sutures that are placed in the diaphragm to fix the hernia. The pain is usually the worst the day after surgery and slowly subsides after that (it can take a week or two). Heat to the shoulders tends to do better than the narcotics for this type of pain.
Activity: We generally restrict heavy lifting (anything you have to strain to lift) for about a month after surgery. Most people return to a desk job after a week or two, and to a strenuous job after a month. Most patients are on narcotics for 3-5 days after surgery. You can drive when you are no longer taking pain medications. There are no restrictions on flying. You can shower, take a bath, or sit in a hot tub any time after surgery.
Diet: If you had surgery on your ankle or knee, you would probably be on crutches for a little while after. The “crutches” for surgery on the stomach and esophagus is diet. After surgery, your esophagus is swollen temporarily from the surgery. Given that your esophagus is a tube, when it swells, the diameter or opening gets smaller. So, for the first 2 weeks after surgery, your diet consists of yogurt consistency or thinner. If it goes through a kitchen funnel, you can have it. If you have to chew it, you cannot have it. Then your diet is advanced to soft mushy foods (well steamed vegetables, well done pastas, fish) for a few weeks. We generally discourage bread and meat for at least a month after surgery. After a month, it is trial and error. There may be some foods that just don’t agree with you after and you need to avoid them. Most people (over 90%) return to eating what they were eating before surgery after about 4-6 months (yes – it can take that long).
The diet is a little different if you have the LINX procedure for reflux. This is a small necklace of magnets that go around the esophagus and help control reflux by helping the valve to stay closed. When you swallow, the pressure generated in the swallow opens the magnets and then the magnets pull the valve closed again after the food/liquid goes through. After this procedure, we want you to swallow something that is a yogurt consistency every 3-4 hours during the day. You can advance your diet back to normal as your recovery allows. This process does take time and can take 6-10 weeks.
Follow up: We will be in touch with you shortly after surgery, at 2 weeks, 3 months and again at a year after your surgery. If you are having any problems or issues after surgery, we would like to know so that we can address it as best as possible. It can take a few months for your stomach and intestines to fully recover from surgery. Nausea, bloating, diarrhea (intermittent), excess flatulence, difficulty swallowing are all normal during recovery. If you are concerned about your symptoms, please contact us.