Immediately after Surgery
Waking Up Post-Surgery
The patient awakens to find a number of tubes exiting from the body. Each incision has a tube to drain the wound area. There is a feeding tube in the belly, usually installed previous to the surgery. A tube in the nose and throat (NG, naso-gastric tube) drains fluids that may build up in the rebuilt gastric system. Needles in the arm and possibly in the spine supply drugs to control the pain from the surgery. There may be inflatable cuffs around the calves that periodically inflate and deflate to help the circulation and prevent blood from pooling in the legs. Last, but definitely not least, a tube is present to drain urine (catheter) for the first days while you remain in bed.
Pain Management
The patient will undoubtedly experience pain and discomfort, to a greater or lesser degree depending on the invasiveness of the surgery. Often, the patient is given some control over the pain with patient controlled anesthesia (PCA), in which the patient can press a button to administer pain drugs when needed. It is important to note that the overall amount of drugs administered is controlled by the medical staff and therefore it is almost impossible to over-administer or develop dependence on the drugs.
Breathing
The surgical staff may have collapsed one of the lungs during the surgery. It is extremely important to perform breathing exercises after surgery to expand the lungs and eliminate any fluid build-up that could result in pneumonia. The patient is asked to breathe into a spirometer which indicates the strength of breathing, and to cough often to expel fluids and mucus. These are hard and uncomfortable exercises, but are vital to healthy recovery. The spirometer is especially useful as a motivational item, with the patient tending to want to improve each reading over time.
Getting Around
Walking after surgery has major benefits for a faster recovery, although it may not feel that way to the patient. The staff will help the patient out of bed as soon as possible and assist them to walk, monitoring the patient’s oxygenation to prevent over-exertion. Later in the hospital stay, the patient will be asked to climb one or two flights of stairs; a major test of the patient’s readiness to finally go home.
Eating
A major post-operative risk is leakage at the junction of the esophagus and the stomach. A leak here can lead to food and drink entering the chest cavity and causing systemic infection. Therefore, the patient will be fed nothing by mouth for several days after the operation; even water is denied. The patient is fed through the feeding tube until tests prove that the junction is sound. After the successful tests, the patient can begin to eat very soft foods, slowly working toward a more normal diet.
The surgery is similar to a gastric by-pass in the dramatic reduction of stomach volume. With time, the remaining stomach tissue will stretch back a more normal size. However in the first year or so, the food intake per meal is dramatically reduced (common guidance is less than your fist).
Risks from Surgery
All surgery has its risks, both during and after surgery. The more major the surgery, the greater the risks. Remember, hospitals that perform the greatest number of surgeries for esophageal cancer have lower figures for morbidity and mortality. So careful choice of hospital, based on the number of esophagectomies performed annually, along with a concentration on working toward a fast recovery, may increase the chances of a successful operation.
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