Dietetics - What can I eat after Anti-reflux surgery?

This information is for people who have undergone surgery to correct reflux disease (Nissens Fundoplication) or other gastrointestinal surgery such as Hellers Myotomy, hernia repairs and repair of achalasia.

Following your surgery, your gastrointestinal tract (or food pipe) takes time to heal and recover. Good nutrition is an important part of your recovery. However, eating too much at one time or food with the wrong consistency may result in food items getting stuck and/or problems like nausea (feeling sick), retching, vomiting or pain. As well as being uncomfortable for you, it can also cause complications and delays in healing.

To promote a comfortable recovery and reduce the risk of complications it is recommended that you modify your diet for roughly 6 weeks after surgery.
 
Meal suggestions for each stage can be found below.

Stage 1 – Liquid diet – 2 weeks

Your surgical team will advise when they feel it is appropriate for you to progress with your oral intake. Usually, you will start with ‘clear fluids’ on the day of your operation and progress to ‘free fluids’. Once you are managing free fluids well and there are no concerns you will be advised to follow a liquid diet, progressing to pureed food.

Stage 2 – Pureed diet – 2 weeks

Pureed food is similar to the consistency of smooth baby foods. You may require the use of a hand blender/food processor to puree foods.

Stage 3 – Soft diet – 2 weeks

Soft foods have more texture, but must still be well cooked and easy to digest. This can include foods that can be mashed with a fork.

Stage 4 – Normal diet with general healthy eating principles

You should start to be able to get back to your normal diet by week 6, with the exception of some foods which are discussed on the following page. Gradually, these foods can be reintroduced as tolerated.

It is important that you only progress on to the next stage when you feel ready. Do not worry if it takes longer than 6 weeks to return to a normal diet. If you are having swallowing difficulties, pain or discomfort, then you should delay progressing to the next stage. You may find that you can only manage smaller portions, so it is important to stop eating when you are full and eat more often than usual.

Foods to be avoided:

Until you return to your normal full diet, it is important to avoid the following foods as they may cause side effects such as abdominal pain, bloating or swallowing difficulties. These should be reintroduced last:

• Bread or cakes as they tend to clump together and can be difficult to swallow
• Large pieces of meat e.g. steak, as they can be more difficult to chew and swallow
• Uncooked raw vegetables, vegetables with skins, nuts, popcorn
• Stringy/fibrous fruits and veg e.g. green beans, pineapple, oranges
• Fizzy drinks and chewing gum as they can cause excess gas and may cause discomfort
• It is also advised to avoid drinking through a straw

General tips to help with eating:

• Allow plenty of time to eat your meals and snacks, relax and enjoy your food
• You may need to eat smaller meals more often
• Stop eating when you are full
• Drink plenty of fluids throughout the day. If you have lost weight try to drinks fluids high in calories such as milk and milkshakes, fruit juice, hot milky drinks, fruit squashes and soups
• Take small bites and chew food well before swallowing
• Moisten food with sauces or gravy
• If you get full quickly, avoid drinking with your meals
• Sit upright when eating and for at least 1 hour after finishing and avoid eating late at night

It is important to try to include a variety of foods in your diet. Here are a few ideas on the best foods to choose for the different stages.

Liquid diet

Clear Fluids - water (still), sugar-free squash, black or herbal tea or coffee (no sugar)

Free Fluids - Any of the clear fluids mentioned above, plus:

• Milk/milk alternatives
• Juice (no bits)
• Tea/coffee with milk/milk alternatives and/or sugar
• Milkshake/dairy free alternative drinks (no lumps)
• Hot chocolate
• Smooth soup (no chunks or lumps)
• Smoothies (no bits)
• Nutritional supplement drinks

Pureed Diet

Foods must be smooth and moist, containing no lumps. To achieve a suitable texture use a food blender or processor, or push well cooked food through a sieve. In most cases this can be the same meal that you family is eating, but yours should be blended until it is the correct consistency.

Sample meal ideas

Breakfast:

• Smooth porridge or wheat biscuits left to go soggy, with milk/ milk alternative

Lunch:

• Pureed beef casserole or fish in parsley sauce
• Smooth, mashed potatoes and carrots
• Pureed silken tofu with vegetables in sauce
• Pureed rice pudding with seedless jam

Evening meal:

• Pureed lentil curry or pureed macaroni cheese
• Creamy, smooth soup

Snacks/desserts:

• Milky drink e.g. latte, malted drink, hot chocolate
• Chocolate mousse
• Pureed tinned fruit and cream/yoghurt/dairy free alternative
• Jelly and ice cream

Soft diet

Foods should be moist, easily mashed with a fork and are best served with a sauce. Any food that is not naturally soft should be finely chopped or mashed using a fork or potato masher.  Cooking foods well will help to produce a softer texture and make them easier to mash.

Sample meal ideas

Breakfast

• Porridge or softened cereals with milk/milk alternative
• Stewed fruit such as apple or banana with yoghurt/soya pudding
• Scrambled eggs/tofu or omelette (soft fillings)

Lunch/evening meal

• Soup with lentils/well cooked meats/vegetables/potatoes
• Well-cooked mince, finely chopped meat or vegetarian alternatives, well cooked in sauce/gravy e.g. Shepherd’s pie, cottage pie, fish pie, corned beef hash, casserole and stew, curries
• Well cooked pasta with lots of sauce e.g. macaroni cheese/ ravioli/cannelloni
• Mashed potato with gravy
• Finely chopped/mashed vegetables, cauliflower cheese
• Skinless jacket potato with tuna mayo/cottage cheese filling

Desserts and snacks:

• Milky/dairy free puddings such as thick and creamy yoghurt, fromage frais, mousse, ice cream or custard
• Sponge puddings with cream, ice cream or custard
• Egg custard or crème caramel
• Jelly or trifles
• Soft tinned fruit, mashed banana
• Fruit juice, smoothies, milkshakes

If your appetite is poor, the following ideas can help you add extra nourishment to foods:

• Use full cream milk rather than semi-skimmed, try adding double cream or sugar
• Add butter, full fat margarine/vegetable spread, mayonnaise, salad cream, oil based dressings, jam, honey, nut butters or marmalade to your food
• Add cheese, butter, cream to mashed potatoes or vegetables
• Try grating cheese over eggs, baked beans, hot pot, savoury mince or in soups
• Add double cream into custard, milk puddings or ice cream
• Avoid ‘low fat’, ‘diet’ or ‘reduced sugar’ foods
• Increase your intake of milky/milk alternative drinks and puddings such as milkshakes, hot chocolate, malted drinks or glasses of full cream milk, full fat yoghurts, ice cream or custard
• Add 2-4 tablespoons of dried skimmed milk powder to 1 pint of full cream milk and use throughout the day on cereal/in drinks

 If you are losing weight, please contact your GP for further advice or a referral to your local community dietitians.