The most common side effects during the first-year post-surgery are:

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• Fatigue – it is very common to feel tired for weeks after surgery. This is a combination of the latent effects of the general anaesthetic and pain killers taken after surgery; the body's healing process using up energy; catching up on broken sleep and disruption over the long period of treatment; and the great sense of relief that it’s all over. Rest is the great healer. It is vitally important to listen to your body and rest when you feel tired.

• Because of the surgery the new stomach will be much smaller than before meaning that meal portions need to be smaller. It’s important to eat little but often, up to six meals a day, and snack between meals to maintain a good nutritional intake.

• A feeling of swelling around the incision line, especially around the ribs. This is quite normal and relates to the build-up of scar tissue. In time the swelling reduces and eventually returns to a near normal.

• A continual ‘dull gripping ache’ and occasional sharp nerve-like pains around the incision line. At times this can be quite painful, especially if the person over-exerts themself, twists or lifts heavy objects. Pain can be managed effectively if needed. Consult your Specialist Nurse to find out more.

• Sleeping on the side of the incision can be uncomfortable for several months but eventually improves.

• Constipation! Immediately after surgery the bowel is slow to function properly so constipation is a common experience helped along by very effective laxatives provided on the ward. When at home, constipation can continue to be problematic. It may be caused by pain medication; however, boxes of laxatives supplied by the ward on discharge prove to be very helpful.

• At the other end of the scale, ‘dumping’ or diarrhoea, needing to go to the toilet at very short notice, is also common to most recovering patients for up to the first year and sometimes longer. Dumping usually occurs after eating too much food, or after eating food with too much sugar. It is possible to minimise dumping by carefully eating little and often and knowing how to limit sugar intake.

• Avoid eating stodgy foods such as white bread and red meats that are difficult to chew down. These can become partially stuck at the lower end of the new stomach causing discomfort around the sternum area for up to an hour after eating. Chewing carefully helps to avoid meal-related aches and pains.

• If the sternum area becomes regularly more painful after eating, it may mean the pylorus valve at the bottom of the stomach has gradually tightened and requires an endoscopic ‘stretch’. This isn’t unusual. The procedure is quick and simple, and provides instant relief. If you experience these pains, speak with your Specialist Nurse.

• Acid reflux. For oesophagectomy patients, lying down flat straight after a meal may cause food from the stomach mixed with acid to slide back up into the mouth, because the ‘new stomach’ doesn’t have an upper valve anymore. This can be very unpleasant. To avoid acid reflux it is important not to eat late, allowing 3 hours at least after an evening meal before going to bed. Also, sleeping up at a slight angle using extra pillows helps to stop acid rising in the throat. Gaviscon and Rennie are useful off-the-shelf chewy tablets that help to counter acid reflux. If it becomes a regular problem, speak with your GP and ask to be prescribed ‘omeprazole’, a very effective medication which controls acid production. Long-term use of omeprazole is commonly used by oesophageal patients.

• Acid reflux is less of a problem for patients who have undergone a complete gastrectomy. For gastrectomy patients, sometimes sitting down with both feet resting slightly upwards for twenty minutes can sometimes help to reduce discomfort after eating too much or having too much sugar.

• Excess insulin. The pancreas carries on producing insulin even though you are not eating the quantities that you used to do. For some people this can result in an overwhelming tiredness during and immediately after eating because your blood sugar is low. It is particularly noticeable if you eat a higher proportion of protein to carbohydrates. The feeling passes after about an hour or can be remedied more quickly by taking a couple of Dextrasol tablets. These tablets are available off the shelf in most chemists and are a handy thing to keep close by after a meal.

• Voice changes. On very rare occasions, the vocal cords can be affected by surgery and the voice softens. It usually returns to normal within a year but if not, treatment options are available.