Post-Op

Returning to Normal

Returning to normal may take a few weeks or months, depending on your body's healing power. Most patients feel much better, and they are able to eat and enjoy life without reflux.

Pain

There is usually minimal pain associated with this operation. The abdomen will be sore as well as the small incision sites, and some patients have shoulder pain for the first day or two. The shoulder pain is caused by gas left in your abdomen during the operation. It will disappear on its own. When you are discharged home you will be given a pain medication to take if necessary. The first few days you may want to take the pain medication so that you will be more comfortable. As you become more active the amount of pain medication needed should decrease quickly.

Diet

Most patients are concerned about what they can eat after the Nissen fundoplication. Immediately after the surgery you will be permitted liquids only. Then for the first few days, you should remain on liquids, slowly adding soft or creamy foods that are easily digested. A diet guide can be found on the last page of the pamphlet. After the initial recovery period most patients can tolerate a variety of foods without difficulty. Some patients find that initially and for the first few weeks, food feels as though it is difficult to get down, this is usually associated with the swelling around the esophagus from the surgical procedure. These symptoms may last 6 to 8 weeks after the operation.

Wound Care There will be five small wounds on your abdomen after the operation, four under your ribs and one at the belly button. These wounds are usually closed with dissolvable stitches. These areas need to be kept clean. You may shower and bathe when the bandages are removed. You should look at the wounds every day and call the GI Surgery Nurse at (919) 966-8436 if there is redness or any bleeding from these areas. Sometimes you will notice bruising around the wounds, this is normal.

Driving a Car

As long as you are not taking pain medicine stronger than Tylenol and when you feel as though your reaction time is normal, you may begin driving. Do not drive if you are taking any kind of pain medicine or medicine that impairs your judgment. Most patients wait until they no longer feel their abdomen is sore.

Work

Most patients feel strong enough to return to work in a 1 to 2 weeks following the operation. Some patients may return to work sooner if they do desk work. If you do work that requires you to lift or bend then you may need to be placed on restricted work duty until you have your post-operative appointment. If you need a letter or work excuse to be sent to your employer, please let your surgeon or the GI Surgery nurse know.

Bowel Habits

Normal bowel habits may be altered by several factors regarding surgery. Constipation is common. Anesthesia, decreased activity and narcotic pain medications are factors that may cause constipation. You should be aware to increase fiber in your diet as soon as possible and to increase your fluid intake. If necessary you may take a mild laxative.

Activity and Exercise

Patients feel like doing activities within a few days of having their operation. You should not lift anything heavier than 8 to 10 pounds (a gallon of milk) for 2 weeks. After this period of time you can begin lifting heavier objects being aware that if your abdomen hurts you should not be lifting. Walk as much as is comfortable for you, moderate exercise helps improve circulation.
You can shower the day after the operation.
You can resume sexual relations when it feels comfortable for you.

POTENTIAL PROBLEMS

As with any operation there is a possibility of complications. Your surgeon will discuss these with you. Some potential short-term complications that may arise shortly after the operation are:

  • Dysphagia-meaning difficulty swallowing. This can occur for a few days or up to a few months following this operation. It is believed that the swelling around the area in the stomach and esophagus causes the patient to feel discomfort when swallowing food.
  • Infection-infection can occur with any operation. Every step is taken to ensure that this does not take place.
  • Wound infection-these infections are usually superficial or on the surface, and can be treated by draining the infected site.

Long term complications that may arise months or years after your operation include:

  • Return of reflux symptoms-a return of symptoms could mean that the stomach wrap around the esophagus has "slipped" or loosened allowing stomach acid to once again splash up into the esophagus.
  • Hernia-A hernia is a protrusion of tissue through a weak spot in your incision. Hernias are not common after laparoscopic surgery, but do occur. An operation is necessary to repair the hernia.

Conclusion

Most patients feel much better following this operation. There many advantages to no longer having reflux:

  • resume normal activities and exercise
  • no longer need expensive anti-reflux medications
  • chronic lung infections and asthma may be decreased
  • better sleep at night without awakening from reflux
  • further damage to the esopahgeal lining may be eliminated

The surgeons here at UNC Hospitals have been performing this procedure since its inception in 1994. They have experience in all aspects of care regarding patients with gastrointestinal reflux. We encourage you to speak to patients who have had this operation. We are glad to give you the names of previous patients who are willing to talk to potential patients.

This information has been provided to help patients understand laparoscopic Nissen fundoplication. You should talk with your physician about any medical advice dealing with your medical diagnosis.

DIET GUIDE

Diet Suggestions for first days:

Carnation Instant Breakfast
Ensure/Resource
Juices
Milk
Soups without vegetables or meat
Gatorade
Milkshakes

Gradually add after 2 days to 2 weeks:

Ice cream
Oatmeal
Grits
Cream of Wheat
Thicker soups

Continue to add after 2 weeks:

Pasta
Mashed potatoes
Cooked vegetables
Cooked or processed fruit
Creamed soups
Bread

Add last:

Meat
Raw vegetables
Raw fruit