This information is for patients who have had an operation on the stomach or oesophagus. This includes anti-reflux or fundoplication surgery, repair of a hiatus hernia and surgery to treat achalasia (cadiomyotomy).

Why do I need to change my diet after surgery?

Surgery can cause swelling and bruising of the stomach or oesophagus. This can temporarily make swallowing difficult. This usually improves after several weeks but, in order to avoid food getting stuck in the oesophagus, we ask patients to follow a special diet after surgery.

What does this involve?

There are three stages to the post-surgery diet. These are:

• Liquid diet
• Puree diet
• Soft/fork-mashable diet

Most patients start on a liquid diet, then move on to a puree diet followed by a soft diet. Patients can then slowly return to a normal diet.

How long will I need to follow this diet?

The amount of time you spend on each stage will depend on what type of operation you have had. Your surgeon will tell you how long to be on each stage and when you can return to your normal diet.

General tips

• Eat smaller meals more frequently rather than three big meals a day (aim for 6-8 smaller meals spaced throughout day)
• Try to eat moist foods with a sauce or gravy
• Take your time with eating and drinking
• Chew your food well and carefully
• Sit upright when eating and for 30 minutes after eating

Are there any things that I should avoid completely?

Yes. Very dry foods and lumps can all get stuck in the food pipe. This can be uncomfortable and, in some cases, may need you to return to the hospital.

Foods to avoid

X  Dry meat, tough meat, gristle, crackling

X  Fish with bones Fish in crispy batter or breadcrumbs

X  Lumps of hard cheese Food with grilled cheese toppings Dairy products containing hard pieces e.g. nuts, dried fruit

X  Fried egg

X  Undercooked beans or peas such as those in salads

X  Soups containing large/hard lumps

X  Wild rice

X  Hard fibrous cereals e.g. All bran, shredded wheat, muesli

X  Any type of bread or toast Dough-based foods e.g. chapatti, naan Pizza Cakes, crumpets, etc

X  Green salad Raw uncooked vegetables Vegetables with tough shells e.g. peas and sweetcorn Stringy vegetables e.g. celery, green beans Gas producing vegetables e.g. cabbage, onion, Brussels sprouts

X  Hard fruits Skins of fruit Dried fruit Seeds and pips

X  Miscellaneous: Hard sweets, toffees, popcorn, crisps, chewing gum, biscuits, crackers

How can I prepare?

You may not feel like shopping and cooking in the first few days after surgery. It is a good idea to get some things ready before you are admitted to hospital. This includes:

• A blender or food processor
• A sieve
• Prepare some puree and soft meals in advance and store them in the freezer
• Go to the shops/ supermarket so that you have some food ready to eat for when you get home.

What do I do if my swallowing is not getting better?

If at any point you are struggling with a certain stage, please drop back to the previous stage. Try to move to the next stage again after a few days. If your swallowing fails to improve, you will need to get in contact with the hospital.

If you are unable to swallow liquids, you will need to come back into hospital.

What do I do with my medications?

This will depend on the type of operation you have had. Some people may be able to take medication as normal. Some people may need to crush their tablets or take them in liquid form. A pharmacist or your surgeon will let you know how to take any medication.

Liquid diet

This is food that is eaten with a spoon or drunk with a cup.

• It should not be possible to eat this with a fork.
• This must have a smooth texture with no lumps or bits.

It is important that your liquid diet is as nutritious as possible and you are drinking enough to stay hydrated.

Tips

• Add cream to increase calorie content of food.
• Fortify drinks with milk (50g (four heaped tablespoons) of dried milk whisked into one pint of full fat milk).
• Drinks such as Meretine, Complan or Ensure are available to buy in pharmacies or supermarkets.

Meal ideas include (but not limited to):

• Breakfast:
  Fruit juice
  Smoothies
• Main meals:
  Soup (remove any lumps with a sieve before eating)
  Milkshakes
• Dessert:
  Ice-cream
  Yoghurts (no seeds or pieces of fruit)
  Custard
  Jelly
  Hot chocolate

Pureed diet

Pureed food should be smooth, moist and contain no lumps.

• Pureed food should hold its shape on a spoon.
• You should not need to bite or chew pureed food.

To achieve a suitable texture, use a blender or food processor.
If you do not have a blender then you can pass food through a metal sieve.

Tips

• Any food can be pureed - ensure it is well-cooked and soft before going into the food processor.
• Remove pips and skins from fruit and vegetables.
• In most cases, you can eat the same meal your family is eating.
• Try to blend each part of a meal separately rather than all in one go. This will make your food more appetising.
• You can use sauces (like ketchup, mustard, soy sauce and curry powder) to give food more flavour.

Meal ideas include (but not limited to):
All food from previous section as well as:

• Breakfast:
  Cereal - must be well soaked in milk and soft
  Milky porridge
  Pureed stewed fruit with yoghurt
• Lunch/ evening meals:
  Pureed casserole or stew
  Pureed vegetable such as potatoes, carrots, peas
  Pureed curry or dahl
  Pureed macaroni or cauliflower cheese
  Soups (remove any lumps with a sieve before eating)
• Dessert:
  Smooth milk puddings like crème caramel
  Mouses
  Pureed stewed or tinned fruit

Soft and fork-mashable diet

This is food that can be easily mashed with a fork.

Food is best served with a gravy or sauce.

Ensure food is well-cooked and is of a soft texture.

Remove the skin from fruit and vegetables, e.g., potatoes.

Ensure vegetables are well-cooked.

Meat or fish must be minced or cut into fine pieces.

Meal ideas include (but not limited to):
All food from previous sections as well as:

• Breakfast:
  Cereal or wheat biscuits well-soaked with milk
  Milky porridge
  Scrambled, poached or boiled eggs, omelette
  Mashed avocado or banana
• Lunch/evening meal:
  Well-cooked pasta in sauce
  Well cooked meat minced or ground and served with a gravy
  Poached or flaked fish (remove all bones) served in sauce
  Quorn, tofu or soya
  Well-cooked soft lentils, beans or peas in casserole
  Finely chopped or mashed vegetables
  Humus
  Skinless sausages – well chopped
  Baked beans
  Hash browns/potato waffles
• Dessert:
  Stewed or tinned fruit
  Tinned or stewed fruits (no skins)
  Soft, ripe fruit, e.g., banana

When can I eat normally?

Your surgeon will tell you when you can return to a normal diet. When you start eating a normal diet, cautiously add in firmer foods items like bread and meat. Continue to chew your food well and take your time.

Can I buy ready-made pureed and soft meals?

Yes. Available at:

• Wiltshire Farm Foods
  Telephone: 0800 066 3549
• Oakhouse Foods
  Telephone: 0333 370 6700

For pureed food meals - search for level 4 meals.
For soft and fork-mashable meals – search for level 5 meals.

What to do if you lose weight

It is usual to lose approximately 3kg (½ a stone) following this procedure.

If weight loss continues after six weeks, please contact your doctor and ask for referral to dietitians if concerns.

If you are experiencing any of the following problems please get in contact, using the contact details below:

• Unable to swallow liquids
• Unable to progress to next stage of diet

Contact information

If your operation was at Wexham Park Hospital or Heatherwood Hospital	Call 07468 354436 Available Monday to Friday 9am to 5pm 07826 921319 Available 10pm to 7am
If your operation was at Frimley Park Hospital	Call: 07990 528 061                 Available 24 hours
If you cannot get in contact, please call 111
If you feel seriously unwell, call 999 or go to the nearest  Emergency Department

To access this information in another format or language

Including:

• Large print
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Please contact the patient advice and liaison service (PALS)

Frimley Park Hospital 0300 613 6530

fhft.palsfrimleypark@nhs.net

Heatherwood Hospital and Wexham Park Hospital 0300 615 3365

fhft.palswexhampark@nhs.net