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Most patients remain in intensive care for only a day or two, before being moved to recuperate on
the Upper GI ward for typically 6 or 7 days prior to discharge. Dieticians work with patients to
provide bespoke dietary plans before they return home. A plan might include continuing with
supplementary liquid feeds through the JEJ tube for a period of a few weeks, combined with a
pureed diet of small regular meals each day. The aim being to adjust to a more normal eating
pattern whilst ensuring sufficient daily calories are provided. The JEJ tube will normally be left in
place for a few weeks until the lead Consultant and Dietician decide it is time to remove it.

Getting home

There will be mixed emotions returning home, from a great sense of relief and determination to get
better, to some degree of trepidation having been released from the care of such fantastic
professionals. Even with a number to call, it can be daunting in the first few days. But be rest
assured, having a dietary plan in place and a simple-to-use feeding tube it won’t be long before more
normal meals are part of the routine again and the JEJ tube can be removed.

Tips for the first 4 weeks at home

• To ensure you don’t miss a meal, set a ‘meal alarm’ on your phone or other device for every
2 hours between 8am – 6pm, or simply use a notepad to tick off small meals as you have
them.
• As you tick off your meals, record what you eat highlighting with a star * the foods you like.
This will help you to fine-tune your meal plan and help identify things you haven’t yet tried.
• Record how much you eat – it is encouraging to know week by week you are able to
gradually eat a little more, or help identify if you are eating too much of something.
• Make a note of how you feel after meals, especially if you experience trips to the loo or mild
aches and pains after eating – this will help you refine the foods that you find either
problematic or trouble free.

Meal portion size

Because of reconstructive surgery your new stomach will be smaller than before and in a different
position, higher up in the chest area. In many cases, five or six small portions a day will be the new
norm. A ‘small portion’ for most of us is approximately 1/3 of what we would normally eat. But
encouragingly, for some, over two or more years stomachs can stretch a little, meaning larger
portions are possible and it is not unusual to return to a normal ‘three meals a day routine’.

Managing weight

Small portions make it inherently difficult to attain sufficient calories to offset weight loss, so it is
vitally important to eat regularly. Initially, we recommend six small meals a day with snacks
between! Absolutely focus on the foods you like the most, especially those high in protein and fats
and some carbohydrate, all of which help to reduce weight loss. This harps back to our
pre-treatment ‘eat what you like’ regime, but following major surgery it is important to combat
weight loss by eating what you like the most, and most often.

Don’t be disheartened if you continue to lose weight. Being persistent and following a routine of
small, regular, nutritious meals, adjusting to what suits you, will eventually help you stabilise weight
loss and reverse the trend. We all have our own natural weight range we feel most comfortable
with. This is a good target to aim for, and once there, it is possible to tailor your diet towards a
much healthier regime for the long term.

B12 and other supplements

Because of the nature of the surgery, your body will not necessarily absorb all the vitamins and
nutrients as well as it did before. In particular, your levels of B12 might be affected. B12 is an