Advice following oesophagectomy

This information aims to advise you regarding exercises following your operation to aid and enhance your recovery.

The lungs following surgery

The lungs can be affected after your operation by the anaesthetic, pain and immobility. Many people find they have a cough after the anaesthetic and it is important that you start to clear any sputum (phlegm) immediately after your operation. If any sputum remains in the lungs it creates the ideal environment for infections to develop.

It is important that your pain is controlled well enough for you to take deep breaths, cough and move around. Most patients will have a button they can press to control their pain relief. If you do not have one, or still have pain, it is important you speak to your doctor, nurse or physiotherapist.

Deep breathing exercises

You should start deep breathing exercises straight away after the operation. While doing the breathing exercises, try to sit as upright as possible and ensure your pain is well controlled.

1. Take a slow, deep breath in (through your nose if possible).
2. Hold the breath for a count of three.
3. Gently breathe out through your mouth.
4. Repeat this four times (do not do too many at once, as this may make you lightheaded).

Aim to do one to two sets of five deep breaths every waking hour.

Mobilisation (walking)

This is an excellent form of exercise after your operation. The benefits of early mobilisation are to promote independence and reduce the risk of developing chest infections and blood clots.

You will be helped into a chair the day after your surgery and assisted to mobilise if appropriate. All your drips and drains are portable and will run on battery power where appropriate. The distance you mobilise should be increased daily. You will initially require assistance to mobilise because of your attachments.

If your mobility is restricted in the early postoperative period, for example from low blood pressure, it is even more vital you continue with your breathing and leg exercises regularly.

Once you are able to mobilise independently you should aim to have a short walk every two hours on the ward. The physiotherapist will do a stairs assessment with you before your discharge if required.

On discharge

Rest is important as well as exercise in the initial stages after your operation. It is common to feel tired after the operation for some time, and you may wish to have a rest in the afternoon. Let your family/friends help with daily activities where required and try to pace your activities evenly throughout the day. It is important to avoid extremes of exercise to prevent strain on the healing wound (ie: heavy housework and lifting, or heavy gardening) for eight to 12 weeks.

Try to increase the length of walking weekly, aiming at around week six to be walking between 20 to 30 minutes (if you were able to do this before the operation). Discuss with your consultant before returning to specific activities.

After discharge, you can get further advice by calling 01223 245151 (the Contact Centre) and asking to speak with the surgical physiotherapy team.

Shoulder mobility

Following your surgery you may be reluctant to move your shoulder, especially on your operation side due to the wound and chest drains. It is important you complete the following exercises on the side of your operation to increase your range of movement and reduce stiffness.

Sit in a good upright position to complete the exercises:

1. Shrug your shoulders up towards your ears then relax back.
2. Gently roll your shoulders forwards then backwards.
3. Place your hand on your shoulder, then gently lift your elbow out to the side then back down.
4. Keeping your hand on your shoulder, gently lift your elbow forwards then back down.
5. Raise your hand in the air towards the ceiling.

Complete each exercise five times, three times a day. You should aim for a gentle stretch sensation.

If the exercises are causing you any pain or discomfort, stop immediately and discuss with your physiotherapist.

Postural advice

Following the operation, you may initially find that you lean towards the operated side, due to the wound. It is, however, important that you maintain a good upright posture to help with wound healing and prevent back and neck pain, and to stand straight when you walk.

'Huff' and cough

It is not harmful to your wound to ‘huff’ or cough after the operation. To make your ‘huff’ and cough stronger and more comfortable, you can use a pillow or towel for support over your wound. To loosen the sputum you may wish to do a huff before a cough. This is a breath in followed by a forced breath out through an open mouth (as if steaming up a mirror).

It is vitally important that you cough as frequently as is required to clear your sputum.

Bed mobility

We advise and encourage you to sit out in the chair/mobilise as soon as possible after your operation (This may be as early as the same day or day after your operation). The ward physiotherapists or nurses will help you with this initially. [image 1]

The most comfortable way of getting out of bed is to bend up your knees with your feet flat on the bed, then roll onto your side. Once you are on your side, put your legs over the edge of the bed and push up through your elbow. [image 2]

Circulation exercises

It is important to start circulation exercises immediately after the operation to help with swelling and to prevent blood clots. Move your feet backwards and forwards briskly 10 to 20 times every 30 minutes. Try also circling your feet, and squeezing your buttocks together to increase your circulation.

Bed exercises

1. [image 3] While lying in the bed, briskly move your ankle backwards and forwards. Repeat this 20 times on each leg.
2. While lying in the bed, gently rotate your ankle clockwise and anti-clockwise. Repeat this 10 times in each direction on each leg.
3. While lying in the bed, squeeze your bottom cheeks together, hold for the count of three then relax. Repeat this 10 times.
4. [image 4] Sitting up in the bed, pull your ankle up towards you then push your knee down into the bed. Hold your leg there for five seconds, then relax. Repeat this five times on each leg.
5. [image 5] Sitting up in the bed, place a rolled up towel under your knee. Pull your ankle up towards you, push your knee into the towel then gently lift your leg up. Try to hold your leg there for five seconds. Repeat this five times on each leg.

Chair exercises

1. [image 6] While sitting out in the chair bend and straighten your ankles, alternating between lifting your toes and heels off the floor. Repeat this 10 times.
2. Sitting in the chair. Rotate your ankles then change direction. Repeat this 10 times.
3. [image 7] Pull your toes up towards you, tighten your thigh muscle and straighten your knee. Hold it there for five seconds then slowly relax your leg. Repeat this five times on each leg.
4. [image 8] Lift your leg up off the seat keeping your knee bent. Return to the starting position. Repeat this five times on each leg.