What kind of equipment will I have?
Right after surgery you will have the following monitoring equipment and tubes:

Heart monitor - watches for any changes in your heart. Leads (sticky patches on your skin) on your chest attach to a monitor much like a TV screen so your heart's activity can be watched.

Oxygen saturation - reports how much oxygen your blood is carrying. It is sometimes called an "0₂ sat." A probe is attached to your finger, earlobe, or forehead. The probe goes to a machine that shows a number. A normal "0₂ sat" is 95-100%, but can vary depending on the your medical history.

Urinary catheter or "foley catheter" - is a tube that is placed in your urinary bladder during surgery. It drains the urine as your kidneys make it. Your nurse and doctor will be watching your fluid balance (also called Intake and Output or "I's and O's").

Nasogastric tube or "NG" tube - is a tube that goes through your nose and into your stomach. The tube is taped to your nose and pinned to your gown so that it doesn't move. If it moves, it can make your nostril sore or the tube could come out.

The NG tube is VERY important. It must not get moved! It will have suction applied to it to remove the secretions and gas that collect in your stomach or bowel after surgery. This prevents bloating that can cause tension on the suture lines. The suture line is where the surgeon has sewn the remaining esophagus to the stomach or bowel. If the bowel was used, there would be a suture line in the bowels as well.

Tell your nurse if you feel nauseated or if you vomit. The NG tube may need to be checked by the doctor.

Chest tube - is a tube that is placed in your chest during surgery. It comes out of the chest near the chest incision. It is stitched to your skin so it stays in place. The chest tube removes drainage and air from the chest cavity. It allows the lungs to re-expand. It also plays another very important role. It helps detect if there is a leak where the esophagus and stomach (or bowel) are sewn together.

Jackson Pratt drain or JP drain - is a soft tube near each internal suture line (anastomosis) placed during surgery. This is where the remaining esophagus is sewn to the stomach (or bowel). The drain comes through the surface of your skin. Like the chest tube, its job is to help the nurses and doctor watch for signs that the suture line is not holding or "leaking". To help pull the drainage from inside the body, the JP is attached to a bulb. The bulb provides gentle suction. The JP is stitched to your skin so it stays in place.

Jejunostomy tube or J-tube - is a soft rubber tube that is placed into your jejunum (small bowel) during surgery. The tube comes through the surface of your abdomen. It is stitched at the skin so it doesn't fallout accidentally. This tube is very important, since it is the way you will receive your nutrition. Until your internal suture lines are healed, you can't eat or drink anything not even ice or clear liquids.

Feedings (liquid nutrition) will be placed into your small intestine through the J-tube. They will be started once there are signs that your bowels have become active after surgery, usually two to three days. The nurse or doctor know your bowels are active because they either hear bowel sounds or you
are passing gas rectally.

You will receive nutritional liquid through the J-tube so your body gets the calories, protein, fat, and carbohydrates it needs for healing. You will begin with feedings 24 hours a day. Once you are able to eat, the feedings will only be done at night while you are sleeping. The J-tube feeding will continue until you are able to eat enough calories to sustain you and help your body to heal. This could be as long as 2 - 3 months after surgery.

How many incisions will I have and where will they be?
The location of your incisions depends on what part of the esophagus has been removed.

Usually there will be two incisions.

1. The first incision will start below the breast and extend along your side under your arm and extend around under the shoulder blade on your back. This is incision is called a thoracotomy. It allows the surgeon to get to your esophagus, located down the center of your chest.
2. The second incision is on your abdomen. It is usually down the center. It lets the surgeon work on turning the stomach or bowel into a replacement for your esophagus. It also allows for the feeding tube to be placed into your small intestines. The part of the small intestines used for the feeding is called the jejunum.

How does pain control assist in my recovery?
Keeping your pain under control helps you recover from your surgery since it makes it easier for you to:

• Get up out of bed and take walks.
• Exercise your lungs using the incentive spirometer (device for deep breathing).
• Do the tasks that you need to do.
• Enjoy the support and presence of your family and friends.

Your nurse will be asking you to rate your pain. You must tell your nurse or doctor if your pain is not well controlled. The Pain Service will be assisting in the management of your pain. There are number of pain control measures available.

What type of pain control measures are available?
There are a number of ways your pain may be controlled:

• Epidural medication. This is medicine that goes in around your spinal cord to block the nerve impulses of pain.
• PCA. Medication may also be given into your vein by a machine called a PCA. PCA stands for "patient controlled analgesia." You push a button when more medication is needed.
• Pain pills given into your J-tube. Finely crushed pills or liquid pain medications can be given this way.

What are the most important things can I do to help in my recovery?

• Keep your lungs clear! Do this by turning, coughing, deep breathing and using your incentive spirometer! This keeps the secretions from gathering in your lungs and prevents pneumonia. It also keeps the small airways (alveoli) open. A respiratory therapist will help you with breathing treatments to loosen secretions. This will help you cough up and remove these secretions.
• Get up and out of bed to walk the halls. This is good for your lungs and good for your circulation. A physical therapist will walk with you during the day; your nurse will walk with you in the evening. You are expected to walk 3- 4 times per day as well as sit up in the chair.
• Take nothing by mouth (NPO). Don't take ANYTHING by mouth until you are told it is okay, NOT EVEN ICE CHIPS, hard candy or gum. By eating too soon, you put your incision lines at risk of not healing properly.
• Keep your pain under control. Let your nurse know if you are in pain.

When will the NG tube be removed?
The tube will not be removed until it is certain that there is no leak at the incision site. Usually around 7 - 10 days after surgery, a swallow test is performed to see if there is any leaking around the incision site.

If there isn't any leaking, and the stomach is emptying properly, the tube will be removed. You will only be allowed to drink grape juice until the next day. If there is no sign of leaking, you will start on liquid diet, and increase it gradually until you are eating a soft diet of 5 small meals per day.

If there is leaking, the NG tube will remain until the site is well healed. It is important not to eat or drink anything when there is a leak because it will drain into the lungs and surrounding tissues, causing infections and pneumonia.

When will the chest tube be removed?
After you have been drinking grape juice and there isn't any sign of a leak, your chest tube may be removed.

What happens after I start the small meals of a soft diet?
After you have started eating by mouth and are tolerating food, your daytime tube fee dings will stop. The staff will watch how much you are able to eat by doing a "calorie count". During this time, your tube fee dings will only be on during the night.

Why all the attention to the eating and calorie counts?
It is very important for your healing and recovery that you take in enough calories. Your calorie count, body weight and some blood work will help us see how nutritionally sound you are.

When you get home, you will also be keeping a food diary to bring to your clinic visit. The dietitian will look at it. Depending on your intake and weight, your feedings will be adjusted. Your tube feedings will be decreased as you increase the food you take in by mouth. Over a period of a few months, you will be weaned from the tube feedings. The feeding tube will be left in for one month after you are taking all your nutrition by mouth to make sure you can maintain your weight and will not need to restart the tube feedings.

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