Gastric resection and its consequences
The first resection was performed in Germany in 1881, and the technique was named after the surgeon - the Billroth method. There are other methods; the choice of the appropriate one depends on the size of the affected area, the location of the pathology and the general diagnosis. An operation to remove the stomach or part of it is performed for the following indications:
- Malignant neoplasms.
- Perforation and perforated stomach ulcer.
- In the presence of a perforated ulcer in the walls of the stomach.
- Precancerous polyps.
- Extreme obesity.
- Pyloric stenosis.
The following are considered contraindications:
- Presence of metastases.
- Serious diseases of the cardiovascular system.
- Kidney and liver failure.
- Open form of tuberculosis.
- General weak condition of the body.
Classification of resections:
- Economical (up to half the volume of the stomach is removed). Prescribed, for example, for stomach ulcers.
- Extensive (approximately two-thirds removed).
- Subtotal (4/5 organ volume).
- Total (90% of stomach tissue is excised).
If it is possible to do without surgery, drug treatment and diet therapy are prescribed.
The diet after gastrectomy is quite strict, and the recommendations must be followed strictly. As a rule, it is prescribed by the attending physician, taking into account the characteristics of the patient’s condition after surgery. Its general rules are:
- Frequent split meals (5-6 times a day), serving size – up to 150 ml.
- Food should be easily digestible, excluding coarse and difficult to digest.
- Heat treatment is required.
- After eating the main course, you can drink water or a drink at least one hour later.
- The nutritional content of the diet should be as follows: at least 140g of protein, 70g of carbohydrates, 40g of fat (preferably of vegetable origin).
- For the first 6-8 weeks it is better to cook only by steaming or boiling.
- It is advisable to lie down for 30-40 minutes after eating.
- The first meal should consist of predominantly carbohydrate foods - they give the body energy; for dinner it is better to prepare food rich in fiber and proteins.
- Try to eat at the same time: the body gets used to the regime, gastric juice begins to be released in advance and the digestion process goes faster. If you skipped lunch, the enzymes will needlessly irritate the stomach lining.
- Avoid very cold or hot food; the recommended temperature is 50-55 degrees.
- Junk food (fried, smoked, marinades, pickles, fast food) is your worst enemy. Not only the stomach suffers from them, but also the liver, spleen and other internal organs.
- You need to take mineral and vitamin supplements for 1-2 months. Your doctor may prescribe enzyme preparations.
- Chew your food thoroughly. The fact is that under the influence of saliva the process of breakdown and primary digestion has already begun.
- Leave bad eating habits in the past: dry food, eating on the go, fast food snacks. Any action can harm a sore stomach.
- Adaptation to the new diet will take up to 8 months. At first you may lose weight (the so-called dumping syndrome), but gradually your body will adapt.
- The diet should be varied, taking into account allergies and individual intolerances. It is better to immediately discuss your diet plan after gastric ulcer surgery with your doctor.
Prohibited and permitted products
During the initial rehabilitation period (8-15 weeks), the following products are recommended:
- Dietary wheat bread (stale), crackers.
- Soups (cereals, vegetables, but without cabbage).
- Meat (tendons and cartilage are first removed and skin removed) - veal, chicken and beef.
- Fish – pike perch, pike, hake, carp, bream, carp.
- Eggs (1 piece per day, soft-boiled or steam omelet).
- In small quantities milk, kefir, cottage cheese, mild cheese.
- Boiled vegetables (potatoes, pumpkin, zucchini, cauliflower, carrots).
- Fruits and berries (except coarse fiber). Compotes and jellies are made from them.
- Viscous porridges, casseroles made from rice, buckwheat, oatmeal, finely chopped pasta.
- You can add olive or sunflower oil little by little, up to 10g of butter.
- Drinks - tea with milk, diluted vegetable and unsweetened fruit juices, rosehip decoction.
Prohibited products include:
- Pastries and sweets.
- Spices, seasonings, sauces, mayonnaise.
- Marinades, pickles, preserves.
- Fried and smoked food.
- Fast food.
- Canned food.
- Alcohol.
- Cocoa, coffee, carbonated drinks.
- Cabbage, radish, radish, sorrel, spinach, onion.
- Fruits and berries with rough skin.
After 3-4 months after consultation with your doctor, you can include the following products:
- Rye bread, unsweetened cookies.
- Cabbage soup, borscht, beetroot soup, low-fat broth.
- Turkey, rabbit meat.
- Sauerkraut, sour cabbage, greens, tomatoes, cucumbers, green peas.
- A little bit of jam, marmalade, sugar, honey.
- Curdled milk, yogurt.
- Sour cream and spice sauces.
Menu for the first week
Surgeries on the stomach are difficult for the body to tolerate, because this organ performs a number of functions. So, for example, the first rule of the diet after removal of a polyp in the stomach is fasting and gradually increasing the volume of portions. After resection, the patient is fed through a tube with nutrient solutions for 1-2 days. Glucose solutions, saline, and amino acids are also administered intravenously. After examination by a doctor and control tests, from the third day you can give broth and rosehip decoction in small portions.
From the fourth day, slimy porridges, curd and fish purees are prescribed, from the sixth day - vegetable purees and eggs (1 serving no more than 50g). From the 8th day, the serving volume is already 150-200, on the 10th day – up to 400 ml.
Table 1. Indicative menu for the week
| Day of the week | Diet |
| 1st | For breakfast: a glass of kefir, an apple without peel. For lunch: fish broth (120g), stewed meatballs (120g). For an afternoon snack: weakly brewed tea, low-fat cottage cheese (140g). For dinner: stew with vegetables (140g), low-fat yogurt (200g) |
| 2nd | For breakfast: oatmeal with banana (180g), herbal tea. For lunch: meat broth (120g), boiled chicken meat (100g), carrot puree (80g). For an afternoon snack: rosehip decoction, crackers (80g). For dinner: mashed potatoes (100g), beef cutlet (100g) |
| 3rd | For breakfast: rice porridge with berries (180g). For lunch: vegetable soup (200g), steamed meat (100g). For afternoon snack: fruit compote, cottage cheese (100g). For dinner: rice with vegetables (180g) |
| 4th | For breakfast: rice porridge (100g), boiled meat (80g). For lunch: soup with cereal (180g), meatballs (100g). For afternoon snack: baked apples (140g). For dinner: carrot puree (140g), meatballs (120g) |
| 5th | For breakfast: vegetable puree (140g), steamed chicken (80g). For lunch: soup with rice (180g), meat ball (100g). For an afternoon snack: fruit mousse (120g), kefir. For dinner: mashed potatoes (120g), boiled beef (100g) |
| 6th | For breakfast: oatmeal with fruit (180g). For lunch: noodle soup (200g), steamed cutlet (100g). For an afternoon snack: cottage cheese (120g), rosehip decoction. For dinner: baked pumpkin (120g), meatballs (120g) |
| 7th | For breakfast: buckwheat porridge (100g), boiled meat (80g). For lunch: puree soup with vegetables (200g), boiled fish (100g). For an afternoon snack: yogurt, a slice of bread (80g). For dinner: pumpkin puree (100g), stewed fish (100g) |
Medical nutrition for patients who have undergone partial gastrectomy. After gastric resection for peptic ulcer of the stomach and duodenum, post-resection disorders often develop. The most commonly observed is dumping syndrome.
With dumping syndrome, a special type of metabolic disorders is noted, which are based on shifts in biochemical homeostasis associated with a disruption of the neurohumoral regulatory activity of the body. With frequent repetition of pronounced vegetative reactions, serious metabolic status disorders occur - metabolic disadaptation, as a result of which the coordinated and synchronous activity of the gastrointestinal tract organs is disrupted. With functional disorders of the liver and pancreas, a decrease in enzymatic activity and microchanges in the mucous membrane of the small intestine with the development of opportunistic microflora in the intestinal lumen and a decrease in the acid-producing function of the gastric stump, these metabolic disorders can lead to deterioration in the absorption and assimilation of nutrients. Patients experience asthenia, weight loss, anemia, hypovitaminosis, as well as changes in neuropsychic status. In some cases, severe metabolic disorders with the development of nutritional dystrophy are observed.
Medical nutrition in the first days after gastric resection. The diet is built on the principle of gradually increasing the load on the gastrointestinal tract and including a sufficient amount of protein for a faster and more complete restoration of the functions of the digestive organs.
Patients are not given any food for 24 hours after surgery. On the 2-3rd day, if you feel well and there are no signs of stagnation in the stomach, tea with a small amount of sugar, rosehip decoction, low-sweet compote and jelly (mashed), 25% protein enpit 30-50 ml 2 times a day are prescribed.
On the 4-5th day you can include soft-boiled eggs, slimy soups, meat and cottage cheese puree and soufflé. Number of meals - 5-6 times a day in a volume of 70-100 ml per meal.
On the 6th-7th day, the diet is expanded, the portion of protein and other dishes is increased, pureed porridge (preferably oatmeal, bread and rice), and white crackers are added (on the 8th day). By the 10th day, the volume and chemical composition of the diet is closer to normal. Include pureed vegetable dishes (potato, carrot puree). Meat and fish dishes are served in the form of steam soufflés, quenelles and meatballs. We recommend soft-boiled eggs, steam omelettes, and curd soufflés. Food is consumed 6-7 times a day in an amount of 200-400 ml. With each meal, the patient should receive a protein dish.
Diet option with mechanical sparing for patients who have undergone gastrectomy
Indications for use. 1-2 weeks after surgery for 2-4 months. It can also be recommended for a longer period of time in the presence of diseases of the operated stomach (gastritis, anastomositis, peptic ulcer, enterocolitis).
Special purpose. Reduce the inflammatory process in the gastrointestinal tract, stimulate reparative processes, and also prevent the occurrence of dumping syndrome.
General characteristics. The diet is physiologically complete, with a high protein content, a normal content of complex carbohydrates and a sharp limitation of easily digestible carbohydrates, and a normal fat content. It limits mechanical and chemical irritants to the mucous membrane and the receptor apparatus of the gastrointestinal tract, nitrogenous extractive substances (especially purines), refractory fats, fat breakdown products resulting from frying (aldehydes, acroleins) are minimized. Strong stimulants of bile secretion and pancreatic secretion are excluded, as well as foods and dishes that can cause dumping syndrome (sweet liquid milk porridges, sweet milk, sweet tea, hot fatty soup, etc.). The diet is hyposodium.
In case of pronounced dumping syndrome, it is recommended to take the liquid and solid parts of the diet separately: the liquid is consumed 30 minutes after eating a solid meal; during lunch, you should first eat the second course, and then the first. Eat food while lying in bed.
Culinary processing. All dishes are prepared boiled or steamed, pureed. The third dishes that the patient receives during lunch are prepared unsweetened (without sugar) or with xylitol (10-15 g per serving). Sugar is given to the patient’s hands (20-40 g per day), it is better to consume it as a bite.
Chemical composition and calorie content. Protein - 140 g, fat - 110 g, carbohydrates - 380 g. Calorie content - 3000 kcal. Table salt - 8-10 g.
Food temperature. Avoid hot and cold foods. Recommended food temperature is 55-56 °C.
Day-old wheat bread, wheat bread crackers, unsweetened cookies.
Soups. On vegetable (excluding white cabbage), cereal decoctions, pureed, low-fat meat broth once a week.
Meat and fish dishes. Lean meat without tendons (beef, chicken, veal) and minced fish (cod, pike perch, carp, pike, bream, navaga, silver hake, carp) (mashed potatoes, soufflé, dumplings, meatballs, rolls, cutlets). These products are boiled, steamed, baked (with preliminary boiling).
Eggs. A soft-boiled egg (no more than 1 egg per day), white omelette or one egg.
Milk in dishes and for tea, if tolerated - whole milk. Kefir is allowed 2 months after surgery. Sour cream as a seasoning. Non-acidic cottage cheese, freshly prepared, pureed.
Vegetable dishes and side dishes. Boiled pureed vegetables. Boiled cauliflower with butter, stewed zucchini and pumpkin, carrot and mashed potatoes.
Fruits, berries, sweets. Fruits and berries (fresh and dry) in the form of unsweetened pureed compotes, jelly, jellies, mousses. Baked apples without sugar. Fruits and berries with coarse fiber (pear, quince) are not allowed. Compotes with xylitol (10-15 g per serving). Sugar, honey, sweets, jam are sharply limited.
Unsweetened pureed, viscous porridges, puddings, casseroles made from rice, whole grains, rolled oats. Semolina is limited. Finely chopped pasta, boiled.
Fats. Add butter, ghee, olive, sunflower, refined (do not fry) to dishes in its natural form.
Snacks. Mild cheese (Yaroslavl, Russian, Uglich), grated, pressed, granular caviar, homemade meat pate, jelly.
Sauces and spices. Sauces based on vegetable broth, sour cream sauces.
Drinks and juices. Weak tea and coffee with and without milk. Unsweetened fruit juices (except grape), berry and vegetable juices. Decoction of rose hips.
Prohibited: products made from butter and hot dough, brains, liver, kidneys, various pickles and smoked foods, marinades, canned meat, fish and other snack foods, smoked sausage, cold and carbonated drinks, chocolate, cocoa, ice cream, alcohol, white cabbage, legumes , spinach, sorrel, mushrooms, radishes, rutabaga, onions, garlic, spices.
Diet option without mechanical sparing for patients who have undergone gastrectomy
Indications for use. 2-4 months or more after gastrectomy with a mild form of dumping syndrome and a moderate form, in the presence of complications with cholecystitis and hepatitis.
Special purpose. Prevent and reduce the manifestation of the dumping reaction, contribute to the normalization of the functional state of the liver and biliary tract.
General characteristics. The diet is physiologically complete, with a high protein content, a normal content of fats and complex carbohydrates with a sharp limitation of simple carbohydrates, with a normal salt content (15 g), not mechanically sparing, with a moderate limitation of chemical irritants of the gastrointestinal tract, with the exception of strong stimulants of bile secretion and pancreatic secretion, with the exclusion and limitation of foods and dishes that cause the development of dumping syndrome.
Culinary processing. All dishes are prepared boiled or steamed and served unpoured. Individual baked dishes without a rough crust are allowed. The third course for lunch is served unsweetened or cooked with xylitol (10-15 g per serving). Sugar is given to the patient's hands.
Chemical composition and calorie content. Protein - 140 g, fat - 110 g, carbohydrates - 390 g. Calorie content - about 3100 kcal. Table salt - 12-15 g.
Diet: fractional (5-6 times a day).
Food temperature. Food is given warm; Hot and cold foods should be avoided.
Bread and bakery products. Day-old gray wheat bread, savory and unsweetened varieties of bakery products and cookies. Rye seeded bread.
Soups. On vegetable broths and cereals, vegetarian. Borscht, cabbage soup, beetroot soup made from fresh cabbage. Low-fat meat soup once a week.
Meat and fish dishes. Various products made from lean beef, veal, chicken, rabbit, lean fish (cod, pike perch, carp, navaga, pike, carp, etc.) are boiled, baked, stewed, without needing to chop.
Eggs. Soft-boiled eggs (no more than 1 egg per day), white omelet.
Dishes and side dishes from cereals, pasta. Friable and viscous porridges, puddings, casseroles from cereals - unsweetened; boiled pasta, in the form of casseroles. Buckwheat, rolled oats and rice porridges are recommended. Semolina is limited.
Vegetable dishes and side dishes. Vegetables raw, boiled, baked, stewed. Non-acidic sauerkraut is allowed. Boiled cauliflower with butter, stewed zucchini and pumpkin, salads, vinaigrettes, green peas. Tomatoes with vegetable oil. Early raw, finely chopped greens can be added to various dishes.
Fruits, berries, sweet dishes, sweets. Raw fruits and berries are not very sweet. Unsweetened compotes, jelly, mousses. Limit grape juice, which causes bloating. Sugar, honey, sweets, jam are sharply limited.
Milk, dairy products and dishes made from them. Milk with tea and other drinks or as part of various dishes, if tolerated - whole milk, curdled milk, kefir, acidophilus milk. Sour cream as a seasoning and in salads. The cottage cheese is not sour, fresh.
Fats. Butter, ghee, olive, sunflower.
Snacks. Mild cheese, low-fat herring, doctor's sausage, dietary sausages, homemade meat pate, ham without lard. Salads, vinaigrettes, jellied fish with gelatin, jelly with gelatin.
Sauces and spices. Sauces based on vegetable broth, sour cream sauces. Onions and green onions in very moderate quantities.
Drinks and juices. Weak tea and coffee with and without milk. Unsweetened fruit, berry and vegetable juices. Rose hip decoction.
Prohibited: the same foods and dishes as with the pureed version of the diet, except those made from white cabbage.
An approximate one-day menu of an unprocessed diet after gastric resection
8 hours (breakfast)
Boiled fish with butter and chopped egg, or homemade cottage cheese, or an omelet, or a steamed cutlet. Oatmeal or buckwheat porridge, crumbly, half and half with milk and water, without sugar. Tea with sugar and lemon.
11 o'clock (second breakfast)
A sandwich with cheese or doctor's sausage or a soft-boiled egg. A glass of kefir, or tomato juice, or yogurt. Fresh apple without peel or soaked or 200-300 g of watermelon.
14 hours (lunch)
Fresh vegetable salad or vinaigrette with vegetable oil. Potato soup with meat broth, vegetable pickle, noodle soup, fish soup - half a plate. Boiled meat or chicken, fried cutlets, beef stroganoff, stew (beef or chicken, rabbit) with boiled potatoes and peeled pickled cucumber, or boiled vermicelli, or porridge.
17:00 (dinner)
Compote of fresh or dried fruits (sugar as tolerated). Dry cookies or homemade crackers (from white bread).
19 hours (at night)
Buckwheat pudding with cottage cheese, sour cream (or any other dish from the list for breakfast). Baked or soaked apples, or vegetable stew, soaked prunes (if you are prone to constipation), sugar-free compote, or kefir, or yogurt.
All day
Stale rye and white bread 300-350 g.
Methods of using therapeutic nutrition
In the first days after gastrectomy, the patient is prescribed a special diet. After 1-2 weeks, in the absence of complications, a pureed version of the diet can be prescribed. At first, bread in the form of crackers is recommended, and then you can eat stale white bread. In the first days of using the pureed version of the diet, no more than 1-2 dishes are given at one time, and side dishes are limited. Then they gradually switch to a full ration of pureed diet.
After 2-4 months (in some patients after 4-5 months), it is recommended to switch to an unprocessed diet. The transition must be made gradually; in the first days, raw vegetables are given in limited quantities, including them in the first course. It is recommended to include black bread, sauerkraut, and salads later, also gradually. If a patient has anastomositis or a peptic ulcer of any location, then a pureed version of the diet is prescribed.
For patients after gastrectomy, in whom the clinical picture is dominated by symptoms of pancreatitis, a pureed diet option with a slight reduction in fat content is offered. In severe cases of dumping syndrome, a diet without mechanical sparing is prescribed, limiting complex carbohydrates to the lower limit of normal (300 g per day) and completely excluding simple carbohydrates. All dishes are prepared boiled or steamed. This diet option involves the complete elimination of sugar, a reduction in the amount of food taken at one meal (due to side dishes), and more frequent meals. It is necessary to eat lying down and stay in bed for 20-30 minutes after each meal.
Chemical composition of the diet. Proteins - 130 g, fats - 100 g, carbohydrates - 320 g. Calories - 2600 kcal.
If inflammatory phenomena (enterocolitis, peri-visceritis) come to the fore in the clinical picture of the disease, then a pureed diet is used, but with a more severe restriction of carbohydrates, mainly easily digestible ones, sugar is excluded, the number of side dishes is reduced, and salt is limited.
When dumping syndrome is complicated by enterocolitis or intestinal dyskinesia, a diet is used depending on the nature of the disease.
In case of exacerbation of the disease, a pureed version of the diet is prescribed with the exception of white cabbage, beets, turnips, radishes, radishes, sorrel, spinach, onions, garlic, mushrooms, millet and pearl barley, melons, apricots and plums.
For colitis with a tendency to constipation and flatulence, an unprocessed version of the diet is given. Ripe tomatoes and leafy lettuce are allowed in their raw form. Excludes: black bread, turnips, radishes, radishes, sorrel, spinach, onions, garlic, mushrooms. Fruits are allowed without peel. Milk is consumed if well tolerated, preferably diluted. It is recommended to introduce an increased amount of food stimulants of peristalsis (cream, vegetable oil in dishes, vegetable juices, vegetables and fruits, bran bread, fermented milk products).
6-12 months after surgery, in the absence of complications from the liver, pancreas and intestines, it is recommended to switch to a diet with regular culinary processing. But even when receiving diet No. 15, the patient must comply with the principles of fractional nutrition and limiting foods that provoke dumping syndrome.
The transition to a more varied diet is carried out in these patients by reducing the degree of mechanical sparing, while chemical sparing persists longer due to persistent secretory disorders of the digestive tract.
For patients who have undergone gastrectomy, without signs of dumping syndrome in the clinical picture, split meals (4-5 times a day) are also recommended for preventive purposes, limiting foods and dishes that most often cause dumping syndrome (sweets, sweet milk porridges, very hot and cold dishes). Food should be taken slowly, chewing it thoroughly.
Medical nutrition for patients who have undergone total gastrectomy. Patients operated on for stomach cancer must be prescribed a complete diet with a limited amount of simple carbohydrates, foods containing animal fat, cholesterol, and an increase in vegetable oil, buckwheat, and sago.
Observations in recent years have shown that patients operated on for stomach cancer quite often experience complications from other digestive organs (pancreatitis, cholecystitis, enteritis, colitis). It is known that patients with organic lesions of the stomach already at the time of surgery have significant impairments in the functional state of the digestive organs and metabolic processes. Therefore, after surgery, as a rule, complications arise from a number of digestive organs. This circumstance poses the task of gastroenterologists to create a diet for patients who have undergone surgery for stomach cancer, taking into account the existing complications.
Patients after gastrectomy who have complications from a number of digestive organs can be recommended the same diet options as for patients who have undergone gastrectomy.
undergoing partial resection of the stomach, only slightly reduced calorie content and with a restriction of animal fat.
The general principles of nutrition for patients after total gastrectomy are:
1. Balanced therapeutic nutrition with sufficient protein*
2. Taking into account the nature of complications arising after surgery.
3. Limiting easily digestible carbohydrates (sugar, honey, jam) and animal fats.
After gastrectomy, a pureed version of the diet is recommended in the first 1-2 months (see above). Then you can switch to the unmashed version (see above). In the long term after surgery for total removal of the stomach, it is better to prescribe a pureed version of the diet to patients with concomitant pancreatitis. Often, patients after gastrectomy experience various types of intestinal dyskinesia. If you are prone to diarrhea, give apples baked or raw without peel, excluding milk and sugar. For constipation, you can add vegetable juices, a decoction of prunes, boiled beets, cream to tea, vegetable oil to porridges, vegetables, and soups to the ungrated version of the diet. In the absence of complications from the digestive organs, an unprocessed diet with normal culinary processing is prescribed.
Patients operated on for stomach cancer are recommended to limit the amount of fat and, if possible, include low-fat foods (low-fat cottage cheese, milk, lean meat, etc.).
Diet option for patients after total removal of the stomach
Indications for use. Gastrectomy with the presence of complications from the digestive organs 1.5-3 months after surgery.
General characteristics. The diet is physiologically complete, with a high protein content, fat content at the lower limit of normal, With limiting complex carbohydrates to the lower limit of normal and sharply limiting easily digestible carbohydrates, With moderate limitation of chemical irritants of the gastrointestinal tract. Exclude stimulants of bile secretion and pancreatic secretion. The diet is hyposodium.
Culinary processing. All dishes are prepared boiled or steamed; frying is not allowed. Food is given unprocessed. Dishes can be baked with preliminary boiling or stewed, removing the first portion of the juice released during stewing.
Chemical composition and calorie content. Proteins - 120 - 130 g, fats - 80 -90 g, carbohydrates - 330 g. Calories - 2700-2800 kcal. Table salt - 8-10 g.
Diet: fractional (5-6 times a day).
The range of products and dishes in this diet does not differ significantly from that in the diet for patients with severe dumping syndrome. This diet includes low-fat protein products - meat, fish, cottage cheese. Oil is added to dishes; it is not served at the table.
The same foods are prohibited as in the diet for patients after partial gastrectomy.
Prevention of complications lies in strict adherence to nutrition and diet. You need to eat often, 5-6 times a day, slowly, in small portions, so as not to overload the stomach. Foods that stimulate excessive bile secretion, pancreatic secretion and the manifestation of the dumping reaction should be excluded from the diet. The lack of motor function of the operated stomach must be compensated for by thoroughly chewing food. The food should be warm (not too hot, but not too cold).
Diet therapy after surgery is carried out in several stages. After 1-2 weeks, in the absence of complications, you can switch to the pureed version of the main diet. During this period, it is necessary to observe the principle of mechanical and chemical sparing of the stomach. After 2-4 months, an unprocessed diet is prescribed, which is not mechanically gentle, but some limitation of chemical irritants of the gastrointestinal tract is still prescribed. If the process of restoring digestive function is successful, by the end of the first year after surgery the list of permitted products can be expanded.
Immediately after surgery
6-8 days after the operation - rosehip decoction, soft-boiled eggs, pureed vegetable soup, pureed liquid porridge (buckwheat or rice), steamed curd soufflé.
On the 8-9th day after the operation, it is allowed to add mashed potatoes, steamed meatballs and fish balls to the menu.
Puree diet
A special diet, which the patient must follow in the first months after surgery, helps reduce inflammation and develop recovery processes in the stomach. All dishes are prepared by steaming or using water. They wipe it down. Preference is given to protein foods. The diet provides for a significant restriction of simple carbohydrates, salt and liquid taken with food
The diet includes:
- pureed vegetable soups (except cabbage) with cereal broths,
- low-fat broth,
- chicken,
- dishes from lean beef and fish (cod, pike perch, carp, pike) in chopped form,
- soft-boiled eggs or steam omelet,
- milk as part of dishes or whole milk (as tolerated).
It is better to use sour cream only as a seasoning; you can start drinking kefir one and a half to two months after the operation.
Vegetables are allowed: boiled cauliflower, stewed zucchini and pumpkin, potatoes and carrots - in the form of puree.
You can make casseroles (without sugar) or viscous porridges from cereals and pasta. It is better not to use semolina for these purposes.
Vegetable oil and butter are used as seasoning for ready-made dishes.
You can eat mild grated cheese.
It is better to prepare jelly and mousse from fruits. Fruit juices are allowed (except grape juice, since it causes excess gas in the intestines), as well as unsweetened tea.
The following foods are excluded from the diet:
- baking,
- liver,
- kidneys,
- lung,
- pickles and smoked meats,
- canned food,
- sausages,
- chocolate and cocoa,
- jam,
- mushrooms,
- legumes,
- onion and garlic,
- White cabbage,
- spinach,
- sorrel,
- radish,
- coffee,
- carbonated drinks and ice cream.
It should be remembered that sweet milk porridges, as well as sweet hot milk and sweet tea are among the products that provoke the manifestation of dumping syndrome, and therefore it is better to exclude them.
The volume of food taken and the range of dishes should be expanded gradually. The first two weeks after surgery, portions should be small. The amount of liquid at one time cannot exceed 200 ml.
Depending on the general condition of the patient, after about 2-4 months it is possible to switch to an unprocessed diet.
Unprocessed diet
This diet is physiologically complete, high in protein, with an almost normal content of fats and complex carbohydrates, but with a limitation of simple carbohydrates. All dishes are still prepared boiled or steamed, baked after boiling and stewed
In terms of the range of products, the unprocessed diet is richer than the previous one, but the nutritional rules and restrictions remain the same.
The list of allowed dishes, in addition to vegetable soups, includes borscht, cabbage soup and low-fat meat soup (once a week). You can eat yesterday's rye, wheat and gray bread, savory cookies, chicken dishes, lean beef and fish. Vegetables are allowed both boiled and raw, including greens and tomatoes with vegetable oil. In addition to milk and kefir, you can drink yogurt and acidophilus. Buckwheat, rice and rolled oats in the form of casseroles, puddings and porridges are recommended. Among the permitted “delicacies” are boiled sausage, diet sausages, black caviar, mild cheese and lean ham, fresh berries and fruits.
The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
Stanislav asks:
What should be the diet after gastric resection for cancer?
After removal of the stomach, you should follow the principle of fractional nutrition, when food is consumed frequently, 5–6 times a day in small portions. At the same time, you should not consume more than two dishes and one glass of liquid at one time. Milk should be drunk diluted with water so as not to provoke increased bile secretion with subsequent nausea and vomiting. It is also absolutely necessary to limit carbohydrate foods (flour products, potatoes, cakes, pastries, sweets, chocolate, sugar, etc.) to avoid dumping syndrome, which is manifested by the development of sweating, weakness, palpitations, chills and cold sweats after eating. . In addition, in the first two months after gastric sleeve surgery, you should consume a minimal amount of salt. Ready-made meals should be taken warm, avoiding cold and hot dishes. Also, all food intended for consumption should be soft and well chopped. The following products are completely prohibited for consumption with a resected stomach:
- Black bread;
- Baked goods made from premium white flour;
- Sweets (chocolate, cocoa, honey, jam, candy, cakes, pastries, etc.);
- Sweet drinks;
- Sparkling water;
- Fresh milk;
- Ice cream;
- Fats of animal origin (lard, fat tail, butter, fatty sour cream, etc.);
- Fatty fish and meats (pork, duck, fatty lamb, salmon, sturgeon, herring, mackerel, etc.);
- By-products (liver, kidneys, lung);
- Any canned food (meat, fish, vegetables, fruit);
- Smoked meats, pickles;
- Sausages and frankfurters;
- Mushrooms in any form;
- Vegetables with coarse fiber (white cabbage, radish, turnip, bell pepper, spinach, sorrel, etc.);
- Alcohol;
- Strong coffee .
So, immediately after the operation, the diet consists of mineral water, slightly sweetened jelly and weak tea. After 2 - 3 days, introduce rosehip decoction, pureed vegetable soup, liquid pureed porridge with water from rice or buckwheat, as well as steamed curd soufflé. By 8–9 days after surgery, mashed potatoes, meatballs, and steamed fish balls are introduced.
After this, for 2–4 months the person is transferred to a pureed diet, which reduces the severity of the inflammatory process and stimulates the restoration of the normal structure of the gastrointestinal tract after surgery. All dishes are steamed or boiled and then pureed. On a pureed diet, you can eat vegetable puree soups with a decoction of cereals, low-fat broth, chicken meat, lean beef and minced fish (cod, pike perch, carp, pike). Soft-boiled eggs and steam omelettes are also allowed. Milk and sour cream can be added to prepared dishes as seasonings. In addition, you can eat boiled vegetables - cauliflower, zucchini, pumpkin, potatoes, carrots, broccoli, beets, kohlrabi, etc. Viscous pureed porridges are prepared from cereals in water. Vegetable oil and butter are used as seasonings in prepared dishes.
The bread should be day-old or slightly dried from whole grain or bran flour. However, bread and kefir can be consumed no earlier than a month after the operation. Fruits are best consumed processed, in the form of mousses, jelly, marshmallows, etc. You can drink fresh juices, with the exception of grape juice.
Then, for 8 to 10 months, the person is transferred to an unprocessed diet, which must be followed for a year after surgery to remove stomach cancer. In this diet, all restrictions remain the same, but dishes can be cooked not only by steaming, but also stewing and baking. You can eat moderately cold and hot dishes. In addition, the diet menu is expanding, which includes borscht, cabbage soup and low-fat meat soup. You can still eat yesterday's bread made from rye, wheat and rye-wheat flour. Low-fat cookies (biscuits, oatmeal, etc.), various dishes from chicken, lean meats and fish are also allowed. Vegetables can be consumed not only boiled, but also boiled, raw, stewed, and baked. During this period, you are allowed to eat fresh herbs and tomatoes seasoned with vegetable oil. If tolerated, you can drink kefir, milk, acidophilus and yogurt. Porridges, puddings, and casseroles are prepared from cereals. For cold appetizers, you can eat boiled sausage, frankfurters, caviar, mild and low-fat cheeses, lean ham, fresh berries and fruits.
Such a diet will have to be followed throughout life, adhering to restrictions on the amount of food eaten at a time, as well as the consumption of flour, sweets and fatty foods.
Cancer at the fourth stage can still be cured! Nutrition according to Shatalova and Moerman
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Surgeons remove the fourth, third, or second part of the stomach; less commonly, a complete gastrectomy is performed. The segment of the organ remaining after the operation takes on all functions, but there is no talk of full digestion. Dietary nutrition after gastric resection for cancer helps to quickly adapt to the new condition.
Nutrition in the first days
Immediately after the operation, the patient cannot eat or drink. All the necessary substances must be injected into his veins in the form of complex solutions (they contain amino acids, glucose, and various salts). On the third day, if everything goes without complications, the attending doctor allows you to drink warm sweet tea in small portions (literally a teaspoon). At the same time, a special liquid diet is introduced into the diet - a protein mixture that is easily digestible and does not irritate the stomach.
Both the process of feeding the patient and the menu in the first days after gastric surgery are the concern of the medical staff. First, food is introduced into the digestive tract through a tube, after it is removed - in the usual way. In order for recovery after gastric resection for oncology to proceed without complications, in matters of nutrition for the patient, it is necessary to strictly follow the instructions of the surgeons.
Diet after surgery
On days 4-6 (everything is determined by the characteristics of the postoperative period), the patient is transferred to normal nutrition. However, the word “usual” does not mean a return to the usual diet, but only a transition to eating diet food. The first stage of this transition period is diet No. 0 (A, B, C), which is indicated after any gastric resection: regardless of whether it was oncology or an ulcer.
№0A
The operated patient should eat frequently (at least 8 times a day), in portions not exceeding 200 ml. All food should be warm, liquid and practically unsalted. The duration of adherence to this diet is determined by the doctor depending on the patient’s well-being. However, in most cases it is 3 days.
The patient is allowed:
- slimy decoction of oatmeal or rice;
- low-fat meat broth;
- jelly;
- rosehip infusion slightly sweetened.
№0B
Diet No. 0B after gastric surgery for oncology resembles the previous version, but there are changes in it:
- the frequency of meals can be reduced to 6-7;
- the size of one serving increases to 250 ml;
- the slimy decoction can be mixed with ground porridge;
- You can add a little grated dietary meat or chopped egg yolk to the broth.
It is advisable to eat according to these principles for 2-3 days or longer if indicated.
№0В
This is the final stage of the operated patient’s transition to a nutritious diet. There should be 5-6 meals during the day. The menu can include:
- egg white omelet;
- puree soup (vegetable or meat);
- low-fat cottage cheese with cream;
- fermented milk drinks;
- baked apples (non-sour varieties);
- crackers or biscuits (50-75 g).
Dumping syndrome
This syndrome is a common complication after surgery to eliminate stomach cancer. It occurs due to the ingestion of undigested carbohydrate foods into the intestines and an excessive rush of blood to the duodenum.
Main manifestations: a feeling of fullness in the abdomen, attacks of severe weakness and fever after eating, and even loss of consciousness is possible. If a patient does not follow a diet after surgery for stomach cancer, the risk of developing dumping syndrome increases significantly.
To prevent this complication from occurring, you must:
- eat more protein foods and complex carbohydrates;
- It is advisable to limit light carbohydrates to a minimum;
- do not eat foods that strongly stimulate the secretion of bile and pancreatic juice (fatty, smoked, spicy, etc.).
Diet after 10 days
10-14 days after surgery on the esophagus and stomach, patients begin to feel much better, but this does not mean that they can not follow the diet. At this stage of the recovery period, diet No. 1 is indicated. Food should continue to be pureed or pureed, you need to eat 5-6 times a day, 250 g each. You can drink no more than a glass of liquid at a time.
It is very important that the patient receives enough protein. To do this, the diet should include protein omelettes, lean fish, dietary meat, and low-fat cottage cheese. Vegetables and fruits should be steamed or boiled and chopped so as not to irritate the gastrointestinal tract.
Nutrition after a few months
During gastric resection for cancer, restoration of the functioning of the gastrointestinal tract takes a long time, so nutrition should remain dietary even several months after the operation. The patient must continue to follow the principles of diet No. 1, but can already eat food in pieces. It is preferable to prepare dishes by boiling, stewing and baking.
6-8 months after gastrectomy, the patient’s menu may be the same as everyone else’s. However, it is very important not to forget about the regime - you need to eat little and often. In addition, a person who has undergone stomach cancer and such a complex operation should not risk his health and eat junk food, much less drink alcohol.
Authorized Products
What can you eat after gastric sleeve surgery? Much - the patient’s diet may well be healthy, varied and tasty.
Doctors include the following approved products:
- porridge (rice, oatmeal, buckwheat);
- chicken, turkey, rabbit, veal;
- unrich meat broths;
- fish (hake, cod, pike perch, pollock);
- omelettes and soft-boiled eggs;
- fermented milk products, cottage cheese;
- cream, butter (in moderation);
- vegetable oil;
- vegetables and fruits;
- jelly, jelly;
- yesterday's bread;
- still water and compotes.
Prohibited Products
Errors in nutrition after gastric resection can cause severe pain and digestive disorders. To prevent this from happening, patients should forget about the following products:
- fatty meats, fish, cheeses;
- offal, lard;
- rich broths;
- confectionery and fresh bread;
- some porridges (corn, pearl barley);
- sausages and smoked meats;
- canned food;
- vegetables containing coarse fiber (especially cabbage, radish);
- legumes;
- pickles;
- mushrooms;
- whole milk;
- ice cream, sweets;
- soda, store juice;
- strong coffee and tea;
- sauces.
Sample menu for the week
The weekly menu for a person who has undergone gastrectomy, at the stage of restoring the full functioning of the gastrointestinal tract, may be as follows:
- Monday. Breakfast – oatmeal, tea. 2nd breakfast – steamed chicken cutlet, berry jelly. Lunch – vegetable soup, a slice of bread, compote. Afternoon snack – baked apple, glass of kefir. Dinner – omelet, boiled fish, tea.
- Tuesday. Breakfast – buckwheat porridge, tea. 2nd breakfast – cherry jelly, two crackers. Lunch – soup with meatballs, bread. Afternoon snack – vegetable salad (boiled), compote. Dinner – rice porridge, cottage cheese. At night - a glass of kefir.
- Wednesday. Breakfast – soft-boiled egg, cottage cheese, tea. 2nd breakfast – baked apple. Lunch – meat soup with cereal, a piece of fish, bread. Afternoon snack – berry jelly, toast. Dinner – mashed potatoes, meat pate (homemade), tea. At night - a glass of yogurt.
- All subsequent days you can alternate these dishes.
The duration and nature of the recovery period after excision of part of the stomach depends to a large extent on how the patient eats. When preparing a diet for such a patient, the doctor makes sure that the operated organ first heals well, and only then learns to re-digest gastric contents.
Useful video about life after gastrectomy
