Esophageal Surgery: Preparation

Preparing for Sugery

1. Adequate nutrition before surgery is very important.  If you are unable to swallow sufficient quantities of food you should use supplemental drinks such as Carnation Instant Breakfast, Ensure, or Boost at least four times every day.
2. Exercise each day before surgery (a minimum of walking twice every day for 30 minutes at a time).  If you are active beforehand you will recover more quickly after surgery.
3. You will need to go to Northern Michigan Hospital’s Pre-Admitting Department a day or two before surgery for preoperative lab work, to meet the anesthesiologist, and to be taught deep breathing exercises by a respiratory therapist.  You will be free to go home after this appointment.
4. A bowel preparation may be necessary. See additional information if so instructed.  

The Day Before Surgery

1. Bowel preparation (see attached information if needed).
2. Prepare items you want to take to the hospital.  Mark all your belongings to help identify them.  
3. In order to help communicate with the medical staff caring for you, you should appoint one family member as a spokesperson to convey your status to the remaining family members. The medical staff will communicate with your family through that spokesperson.  
4. Call 231-487-4840 between 2 p.m. and 4 p.m. on the day before surgery to learn when you should arrive at the hospital the time your surgery is scheduled.  

The Day of Surgery

1. Arrive at Northern Michigan Hospital’s Pre-Admitting Department at your scheduled time.
2. Your family will wait in the Surgical Waiting Room.  Operating room nurses will keep the family updated about the progress of the surgery. When your surgery is finished, the surgeon will talk with the family. Surgery can be as long as 4 to 6 hours, so your family should bring something to do while they wait.
3. Most patients go to the ICU immediately after surgery. Your family will be able to see you soon after you arrive in your room following surgery. 
4. Because this is a major operation, you will awaken from surgery with a variety of important tubes and dressings.  These are routine following this type of procedure and will be removed as you recover.  Remind yourself these are only temporary.

Things You Should Expect

• An abdominal incision plus either a chest or neck incision depending on the tumor location.
• You may have plastic drains or chest tubes which are usually removed in about 3 – 4 days.
• Intravenous lines (IV’s) and monitoring catheters will be placed by the anesthesiologist when you are asleep immediately before the operation begins.
• You may require supplemental oxygen.
• A jejunostomy tube (J-tube) may be placed during surgery. This tube is inserted into your small intestine and brought out through the skin below your ribs. It allows you to be fed temporarily while your esophagus recovers. Because you will not be able to take food by mouth for the first several days, the J-tube will be used during this time. The J-tube will typically be left in place for six weeks or so until we are sure that all operated sites are healing well.
• A nasogastric (NG) tube will be placed during surgery. This tube passes through your nose into your stomach. It prevents the buildup of stomach fluids while healing occurs. The NG tube generally stays in place until an x-ray study 4-5 days after surgery confirms the operated sites are healing satisfactorily. As long as the NG tube is in place, you will not be allowed to eat or drink. After the NG tube is removed, you will be given liquids or soft foods as tolerated.

Activity

It is very important to increase your activity each day. The nurses will help you do this and you should expect to walk in the halls at least 3 to 4 times each day.

It is very important for you to do your breathing exercises every hour while awake using 10 to 15 repetitions.  These exercises will help prevent lung problems such as pneumonia. 

Pain Management

You will be given medications by vien (IV’s) to control your discomfort.  As you are able to take food by mouth, pain pills will be given to replace IV medications.  It is important to that your pain be well controlled. Let the nurses know if your pain is not adequately treated.

After Going Home

• Wash your incisions every day with plain soap and water. You should shower or bathe each day.
• You may feel numbness or a tingling sensation around your incisions. This is a temporary situation which is expected after surgery.
• There may be small pieces of tape (steristrips) reinforcing your incisions. As these become loose over time they should be peeled off. They all should be removed by two weeks after the operation.
• A dressing is not needed over the incisions unless they are draining.

Caring For the J-tube

• The J-tube is secured to your skin with a suture. It should remain clamped and covered unless it is being used to supplement your diet.
• You need to flush the J-tube twice every day with 30 milliliters (1 ounce) of water.  (You should have a syringe to do this).  Clamp the tube after flushing.
• Clean around the J-tube twice a day with plain soap and water then pat the area and cover the tube with a dry gauze dressing.
• A small amount of clear drainage around the tube is normal.  If the drainage looks infected or if you have a fever of 101F or more, please call us. 
• If the skin suture breaks, tape the tube securely to your abdomen and call us.

Exercise

• Increase your activity every day.  Walking is the best exercise and will help your heart, lungs, and bowels to recover sooner.
• It is normal to feel tired for the first 6 to 8 weeks after surgery.  This will get better, particularly if you exercise regularly.
• Do no heavy lifting  nothing more than a gallon of milk  for 6 weeks.
• Do no heavy exercise such as swimming, tennis or golf for 6 – 8 weeks.
• You may resume sexual activities when you desire.

Diet

• You may eat regular food unless you have been put on a special diet. Eating smaller meals more often is generally better tolerated.  Six small meals a day is recommended instead of three regular sized meals.
• You should eat only when sitting up and you should remain upright for at least one hour after meals.
• You may initially have difficulty with some solid foods such as steak or pizza unless these are chewed well. 
• Introduce different foods cautiously.  Spicy foods, sweets, and milk may cause cramping, diarrhea, or indigestion.
• A well-balanced diet will help in the healing process.  Fruits, vegetables, and yogurt are some good choices; these can be mixed in a blender to make a semi-liquid drink if needed.
• If you need supplemental tube feedings, the hospital staff will provide you with instructions.
• You should weigh yourself each day and keep a record of your weight for the first four weeks you are at home. It is important to call if you find you are loosing weight.
• If you develop persistent nausea, vomiting, diarrhea, or constipation, call us.  Your diet may affect how your GI tract functions. Drinking adequate fluids and obtaining regular exercise will help to avoid many of these problems.

Other

You may continue to have some discomfort for 6 to 8 weeks as a result of the surgery.  This should decrease over time.  As the pain decreases, you may want to try Tylenol or acetaminophen (generic for Tylenol).

Resources for esophageal cancer:
American Cancer Society 1-800-227-2345
National Cancer Institute 1-800-4-cancer (1-800-422-6237)
Web sites: