What is Gastric Pull Up Surgery
Gastric pull up surgery is a procedure to remove part of the esophagus and connect the remaining part to the stomach.
You may have this procedure if there is a tumor on your esophagus (esophageal cancer) or if you injured your esophagus by swallowed a harmful substance.
Tell a health care provider about:
- All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
- Any allergies you have.
- Any blood disorders you have.
- Any problems you or family members have had with anesthetic medicines.
- Any surgeries you have had.
- Any medical conditions you have.
- Whether you are pregnant or may be pregnant.
- Whether you smoke or use tobacco.
What are the risks?
Generally, this is a safe procedure. However, problems may occur, including:
- Infection.
- Bleeding.
- Allergic reactions to medicines or dyes.
- Damage to other structures or organs.
- Swallowing problems.
- Breathing problems.
- Lung problems, such as pneumonia or excess air between the lung and the chest wall (pneumothorax).
- Blood clots.
- Voice changes.
- Nausea and vomiting.
- A leak in the part of the esophagus that was connected to the stomach (anastomotic leak).
What happens before the procedure?
Medicine
- Ask
your health care provider about:
- Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
- Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do nottake these medicines before your procedure if your health care provider instructs you not to.
- If you were prescribed an antibiotic medicine to help prevent infection, take it as told by your health care provider.
Staying hydrated
Follow instructions from your health care provider about hydration, which may include:
- Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.
Eating and drinking restrictions
Follow instructions from your health care provider about eating and drinking, which may include:
- 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
- 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
- 6 hours before the procedure – stop drinking milk or drinks that contain milk.
- 2 hours before the procedure – stop drinking clear liquids.
General instructions
- You may have imaging tests done, such as an ultrasound, CT scan, or MRI.
- You may have blood or urine samples taken.
- You may be asked to shower with germ-killing soap.
- Plan to have someone take you home from the hospital.
- Ask your health care provider how your surgical site will be marked or identified.
- Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
What happens during the procedure?
- To
lower your risk of infection:
- Your health care team will wash and sanitize their hands.
- Your skin will be washed with soap.
- An IV tube will be placed in one of your veins.
- You
will be given one or more of the following:
- A medicine to help you relax (sedative).
- A medicine to numb the area (local anesthetic).
- A medicine to make you fall asleep (general anesthetic).
- An incision will be made on the left side of your neck.
- Tissues and muscles will be moved out of the way to allow access to the esophagus.
- The section of the esophagus that is diseased or damaged will be removed.
- An incision will be made from the bottom of your chest to your belly button.
- Tissues and muscles will be moved out of the way to allow access to the stomach.
- Part of the top of the stomach may be cut or removed.
- The upper part of the stomach will be pulled up to the esophagus and attached with stitches (sutures).
- A procedure may be done to widen the opening of the stomach to the small intestine (pyloroplasty).This will help the stomach to empty after surgery.
- A feeding tube called a jejunostomy tube may be placed through the abdomen and into the small intestine.
- Your incisions will be closed with sutures, skin glue, or adhesive strips.
- A bandage (dressing)will be placed over your incisions.
This procedure may vary among health care providers and hospitals.
What happens after the procedure?
- Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
- You
may need to stay in the hospital for several days. Until you go home:
- IV tubes may be inserted to provide you with fluids and medicines.
- Tubes may be inserted into your chest and neck to help drain fluid.
- A tube may be placed through your nose to help provide nutrients while you recover (nasogastric tube).
- You will be given medicines to control pain.
- You will be given antibiotic medicines.
- If you have a feeding tube in place, it may need to stay in place for a couple of weeks. It will be removed when you are able to chew and swallow food.
- You may have swallowing and speech therapy.
- You may be able to start eating food 7–10 days after surgery. You will start by eating small amounts of food, several times a day.
- Do not drive for 24 hours if you were given a sedative.
Summary
- Gastric pull-up surgery is a procedure to remove part of the esophagus and connect the remaining part to the stomach.
- You may have this procedure if there is a tumor on your esophagus or if you injured your esophagus by swallowing a harmful substance.
- Generally, this is a safe procedure. However, problems may occur.
- You may need to stay in the hospital for several days. Until you go home, you may have tubes inserted to provide fluids and medicines and to help drain fluid.
- You may be able to start eating food 7–10 days after surgery. You will start by eating small amounts of food, several times a day.
Gastric Pull-Up Surgery, Care After
This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.
What can I expect after the procedure?
After the procedure, it is common to have:
- Pain and swelling in your throat and neck.
- Pain behind your breastbone.
- Pain when swallowing.
- Regurgitation or acid reflux.
- Diarrhea.
- Nausea.
- Gas and bloating.
- A wet or gurgling sound in your voice.
Follow these instructions at home:
Eating and drinking
- Follow
instructions from your health care provider about eating and drinking
restrictions. They may include instructions to:
- Eat soft, moist foods.
- Drink enough fluid to keep your urine clear or pale yellow.
- Avoid or limit the amount of alcohol you drink.
- Limit the amount of caffeine you drink.
- Avoid
foods and drinks that:
- Are very hot or very cold.
- Are acidic, such as tomatoes or citrus fruit.
- Are fatty, such as fried food.
- Can cause bloating, such as beans, cauliflower, broccoli, nuts, apples, and melon.
- Are carbonated.
- Have a high amount of sugar.
- Eat six small, high-protein meals a day rather than three large meals.
- Take small bites and chew your food thoroughly.
- If a certain food causes discomfort, stop eating it and try it again in a week.
- Always sit up while you eat. Stay sitting up for 45–60 minutes after eating.
- Avoid using straws and avoid sucking (slurping) food or liquid. Those actions can cause you to swallow air, which can make you feel uncomfortable.
- Take vitamins and supplements as told by your health care provider. You may need to take a calcium supplement.
Medicines
- Take over-the-counter and prescription medicines only as told by your health care provider.
- If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do notstop taking the antibiotic even if you start to feel better.
- To
prevent or treat constipation while you are taking prescription pain medicine,
your health care provider may recommend that you:
- Take over-the-counter or prescription medicines.
- Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
- Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
Driving
- Do notdrive for 24 hours if you were given a medicine to help you relax (sedative).
- Do notdrive or use heavy machinery while taking prescription pain medicine.
Bathing
- Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider when it is okay for you to shower.
Activity
- Do notlift anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you, until he or she says that it is safe.
- Avoid activities that require a lot of effort (are strenuous) as told by your health care provider. Ask your health care provider what activities are safe for you.
Incision care
- Follow
instructions from your health care provider about how to take care of your
incision(s). Make sure you:
- Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
- Change your dressing(s) as told by your health care provider.
- Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
Check your incision area every day for signs of infection. Check for:
- Redness, swelling, or pain.
- Fluid or blood.
- Warmth.
- Pus or a bad smell.
General instructions
- Participate in swallowing and speech therapy as told by your health care provider.
- Sleep with your head raised at least 6 inches (15 cm) higher than your chest.
- Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
- If you have a feeding tube, care for it as told by your health care provider. You may need to wash the skin around the tube regularly.
- Keep all follow-up visits as told by your health care provider. This is important.
Contact a health care provider if:
- Your ability to swallow does not improve.
- You have a fever or chills.
- You develop a cough.
- You have redness, swelling, or pain around any incision.
- You have fluid or blood coming from any incision.
- Any incision feels warm to the touch.
- You have pus or a bad smell coming from any incision.
- Your pain does not improve.
- Your nausea does not improve.
- You have acid reflux or heartburn that does not improve with diet changes.
- You have trouble talking.
- You have a fast heart rate.
- You have anxiety.
- You have cramping or pain in your abdomen after eating.
- You lose weight.
Get help right away if:
- You are having trouble breathing or have shortness of breath.
- You have severe pain that cannot be controlled with medicine.
- You cannot eat or drink without vomiting.
- You have blood in your urine or stool.
- You vomit blood.
Summary
- After this procedure, it is common to have pain and swelling in the throat and neck, pain behind the breastbone, pain when swallowing, regurgitation or acid reflux, diarrhea, nausea, gas and bloating, and a wet or gurgling sound in your voice.
- Avoid foods and drinks that are very hot or cold, acidic, high in fat (such as fried foods), high in sugar, or carbonated. Also avoid foods and drinks that cause bloating.
- Eat six small, high-protein meals a day rather than three large meals.
- Take small bites and chew your food thoroughly.
- Sleep with your head raised at least 6 inches (15 cm) higher than your chest.
