Dietary advice following Nissen fundoplication

This leaflet will help you understand more about how you will progress with your diet following Nissen Fundoplication.

We hope it answers some of the questions you may have. If you have any further questions or concerns, please contact the Dietetics department, your clinical nurse specialist, or the surgical department.

Why do I need fundoplication surgery?

A fundoplication is an operation used to treat severe and ongoing acid reflux. The condition is called gastro-oesophageal reflux disease.

Acid reflux is when the acid in your stomach flows back into your oesophagus (food pipe). This irritates the lining of the food pipe, and causes a burning feeling called heartburn.

If you keep getting severe acid reflux, this could be due to the muscle valve between your food pipe and stomach not work properly.

How will changing how I eat help me after surgery?

After your procedure, your gastrointestinal tract will take time to heal and recover. It could be swollen and irritated for a short time, normally 4 to 6 weeks.

We may ask you to change the texture and type of food you eat. Doing this will minimise the following risks.

• Food getting stuck.

• Gastrointestinal problem, including nauseous (feeling sick), vomiting, retching, and pain.

• Wrap / new valve migration.

• Delay in healing.

Why do you need to eat well after surgery?

Eating well is vital in helping you to recover faster from your surgery. If you have a poor appetite and are eating less than usual, you may get weaker if you lose weight.

It is important to have enough protein before and after your surgery. Protein helps wounds heal, and helps you recover your strength. Dairy products, beans, pulses, fish, eggs, and meat are rich in protein.

Do I need a special diet?

Most patients return to eating and drinking a normal diet 4 to 6 weeks after surgery. Your surgeon will guide you on this.

Your texture of food and diet may increase in stages, for example:

• Stage 1: fluid

• Stage 2: blended / puree diet (level 4)

• Stage 3: Softer option of a normal diet (level 6 / 7 easy to chew)

• Stage 4: Normal diet.

This may also depend on how well you are eating at each stage. A dietitian can advise you on how to meet your dietary needs on this diet.

An example of your how your diet may progress

Below are example of foods you can eat at each stage

Bread, cereal, and grains

• Level 4: puree diet

  • Porridge, hot oat cereal such as Ready Brek, instant oatmeal, semolina

  • Well cooked, soft pasta / rice dishes, that can be pureed to a suitable consistency

  • Mashed or instant potatoes can be pureed into a suitable consistency.

• Level 6: soft and bite-size diet

  • Cereals, such as Weetabix or Cornflakes can be soaked in milk

  • Well-cooked pasta and rice

  • Mashed potato

  • Jacket potato without the skin

  • Couscous

  • Bread / toast with crust removed and softened with spread

  • Dunk bread into soups and sauces

  • Soft cakes / muffins and sponge cake.

• Food to avoid to start with

  • Cereal with added nuts and dried fruit

  • Coarse cereal, such as muesli, Oat Crunch, Puffed Wheat, Shredded Wheat and All Bran

  • Fresh, crusty bread / hard pastry / bagels / hot cross buns / doughnuts

  • Biscuits with nuts and dried fruit.

Meat, fish, and poultry

• Level 4: puree diet

  • Pureed meat / fish with plenty of sauce / gravy

  • Pastes and pate

• Level 6: soft and bite-size diet

  • Finely minced or chopped meats

  • Casseroles or stew

  • Have with gravy or sauce

• Food to avoid to start with

  • Tough, gristly, or chunky cuts of meat

  • Hard, crispy meat, such as chops, steak, or bacon

  • Bony fish, crumbled and battered fish, shellfish such as mussels, oysters, cockles, and winkles

  • Calamari, squid, and octopus

Egg

• Level 4: puree diet

  • Egg souffle / custard

• Level 6: soft and bite-size diet

  • Hard boiled egg mashed with mayonnaise / butter / salad cream

  • Scrambled

  • Softly poached

  • Soft boiled

  • Souffle

  • Lightly cooked omelette

• Food to avoid to start with

  • Fried egg

  • Hard boiled eggs

  • Scotch eggs

Beans and pulses

• Level 4: puree diet

  • Cooked or tinned beans and mushy peas can be pureed and sieved before eating. They can then be added to soup / stews or casseroles

  • Cooked, pureed and sieved tofu, Quorn, and texture vegetable protein

  • Smooth humus

• Level 6: soft and bite-size diet

  • Baked beans and other pulses

Milk and dairy products

• Level 4: puree diet

  • Milk puddings, such as custard, ground rice, and semolina

  • Rice, tapioca, sago, and macaroni puddings can be pureed

  • Smooth, thick, creamy, or Greek varieties of yoghurt and fromage frais

  • Egg custard, crème caramel, mousses, and ice cream

  • Blancmange and instant whip

  • Cream cheese, such as cheese spread, ricotta, or mascarpone

  • Melt grated cheese into sauces, but avoid stringy cheese such as mozzarella

  • Milk based thick fruit smoothies with no lumps, skins, or seeds

• Level 6: soft and bite-size diet

  • Grated hard cheese

  • Cottage cheese

  • Soft cheese

• Food to avoid to start with

  • Chunks of hard cheese

Fruit

• Level 4: puree diet

  • Mashed / pureed fruit

• Level 6: soft and bite-size diet

  • Soft peeled fruit

  • Tinned fruit

  • Stewed fruit

• Food to avoid to start with

  • Hard fruit, such as unripe pear

  • Dried fruit

Vegetables

• Level 4: puree diet

  • Mashed or pureed vegetables, such as parsnip, swede, carrots, butternut squash, well ripened avocado

  • Creamed spinach

  • Mushy peas can be pureed and sieved

• Level 6: soft and bite-size diet

  • Well-cooked vegetables

  • Soft canned vegetables

• Food to avoid to start with

  • Raw vegetables

  • Lightly steamed / microwaved vegetables

  • Hard vegetables

Miscellaneous

• Level 4: puree diet

  • Chocolate spread / smooth jam, marmalade, honey, syrup

  • Mayonnaise, salad cream, salad dressing

  • Sauces

  • Butter, oil, margarine

• Level 6: soft and bite-size diet

  • Soft biscuits such as wafers and Jaffa cakes

  • Biscuits dunked to soften

  • Cake served with ice cream / custard

• Food to avoid to start with

  • Nuts and seeds

  • Sweets, such as boiled sweets, gums, toffee

  • Chocolate / biscuits with fruit and / or nuts

Drinks

• Level 4: puree diet

  • All squashes and soft drinks

  • Milk and / or milkshake

  • Complan or build-up prescription

  • Prescribed supplemented drinks

  • Cup-a-soup or build-up soup

  • Smoothies

  • Yoghurt / yoghurt drinks

  • Ovaltine

  • Hot chocolate

  • Horlicks

  • Milky tea / coffee

General guidelines with eating and drinking

• Eat small and frequent meals and snacks during the day, especially if you have a small appetite. Aim for 4 for 6 smaller meals per day.

• Make sure you chew well and eat slowly.

• It is important to have a well-balanced diet. Include a variety of foods from all good groups including protein food. For advice and help, please see the NHS Eating a balanced diet web page.

• Have meals and drinks that are high in calorie and protein, to meet your daily requirements.

• We may ask you to avoid fizzy drinks following your surgery.

• Eating is a source of pleasure, so it is important that you enjoy the foods you are able to eat.

• If you have a small appetite and struggling with your diet, try snacks between meals. You can also increase the calorie and protein content of your food and meals. Add cream, butter, cheese, and / or sugar to foods.

Examples of soft and bite-sized meals

When can I eat and drink as normal?

• Food

  If you need no pain or discomfort on a bite-size diet, you should be able to return to a normal diet 4 weeks after your surgery. Your surgical team will guide you.
  
  Once you are ready to eat a normal diet, introduce food gradually. Aim for a normal diet within 1 to 2 weeks. For example, try to introduce a higher fibre breakfast cereal, and other fibrous food like pulses, nuts and dried fruit the following week.

• Drink

  It is very important to keep yourself hydrated. To prevent hydration, aim for at least 6 to 8 glasses of fluid a day.

  If you still struggle with eating, tell your surgical consultant at your follow-up appointment, or contact the Dietetic department.

Further information

• If you need advice about your treatment or surgery outside normal working hours, please contact your GP or NHS 111.

• In life-threatening circumstances, please call the emergency services on 999.

Contact details 

• Acute Nutrition and Dietetic Department, Kent and Canterbury Hospital, Canterbury
  Telephone: 01227 864236

• Acute Nutrition and Dietetic Department, Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate
  Telephone: 01843 234 310

• Acute Nutrition and Dietetic Department, William Harvey Hospital, Ashford
  Telephone: 01233 616624

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