Light, quickly digestible, in small portions - this is how nutrition should be after gastric resection. Surgical intervention involving the removal of the stomach or part of it is not an easy change in the way the body works. Preparation for it and a long time after the operation itself requires a serious approach and adherence to clear medical recommendations. Resection is required for oncology and peptic ulcer disease, when the damage cannot be cured with medication. When part of the stomach is removed, food passes into the intestines very quickly, and because of this, the patient may experience unpleasant symptoms: bloating, heaviness, fatigue and dizziness. To prevent such conditions from arising, you need to draw up a food intake schedule and revise the diet.
How does digestion take place after resection?
A reduced stomach cannot cope with the digestion of food in full, so poorly processed food is sent directly to the intestines, which cannot absorb all the useful and nutrients. Because of this, the work of the digestive system is overloaded, and the person is in an uncomfortable state, expressed by drowsiness, heaviness in the abdomen, and increased gas production. As a result, there is a lack of vitamins in the body, exhaustion, and rapid weight loss. To avoid such manifestations, both the stomach and the intestines need to be "helped" by eating according to a special system.
Nutritional rules after gastric resection
After the operation, you need to eat 5-6 times a day in small portions. After surgery to remove part of the stomach, the patient has a long recovery period, during which strict rules of food intake must be adhered to. Basic nutritional guidelines:
- eat 5-6 times a day in small portions, because the stomach has become smaller, and it is not able to accept and digest a large portion of food;
- chew food well, eat slowly;
- limit or completely exclude foods with a high carbohydrate content (sugar, honey, jam, baked goods);
- increase protein intake (lean meat, fish, eggs, cottage cheese);
- after taking the first 2, do not eat the third dish immediately, but after at least 30 minutes, that is, drink milk, kefir, jelly or compote after a while, so as not to burden the stomach.
It is necessary to strictly observe these rules for the first 3 months after the operation in order for the adaptation of the digestive system to take place correctly. All food should be grated, it is better to use recipes that involve steaming. The patient may refuse to eat for fear of pain. Such situations cannot be allowed, otherwise malnutrition will lead to depletion of the body.
Menu for the first week
The first day of the week is fasting. The menu for the first 7 postoperative days is usually prescribed by the doctor, taking into account the individual characteristics of the patient. The patient's diet is approximately as follows:
- The first day is fasting. You can take 30 milliliters of water every 3 hours or jelly without sugar.
- After 3 days, the patient is allowed a steam omelet and half a cup of tea for breakfast. The snack consists of jelly and grated rice, boiled in water. For lunch - rice soup and meat puree. After an hour and a half, you can drink a rosehip drink. For dinner - meat or cottage cheese soufflé. Before going to bed, take jelly (no more than half a glass). The same composition of products and on the 4th day.
- In the next 2 days, the diet expands. Breakfast already consists of soft-boiled eggs, meat puree and tea with milk. As a snack, you can eat grated porridge (rice or buckwheat - your choice), and you can dine with a steamed meat soufflé. Afternoon snack - unsweetened curd mass. For dinner allowed: carrot puree and steamed meatballs. At night - jelly again.
- On the 7th day after the operation, doctors recommend eating 2 boiled eggs for breakfast, as well as mashed porridge. The second breakfast consists of steamed curd mass. For lunch, you can have potato and rice soup, plus a steamed cutlet and mashed potatoes. Afternoon snack - steam fish. For dinner you can taste jelly and cottage cheese. White bread croutons are allowed.
The first week after surgery is the most difficult. The patient is just beginning to get used to the new diet. With the introduction of each new product, you need to carefully monitor the reaction of the digestive system to it, so as not to harm the weakened body. If the stomach reacts with severe pain, nausea, weakness and dizziness, you need to stop taking this product for a while.
Diet No. 1 after resection
The patient after gastric resection is prescribed diet No. 1. It is also used to compose different types of menus intended for people with stomach and duodenal ulcers, after gastritis. It is based on foods that are simple and soft for the body. Recipes include steaming, boiling and baking (no crispy). Then everything is thoroughly crushed and grinded. Warm food should be eaten - neither too hot nor too cold can be. If you follow this diet, you need to count calories: the daily rate is 3000 Kcal.
Allowed Products
Sweets and honey must be discarded. It is not difficult to follow a diet, because it allows the use of a lot of tasty and healthy foods. First courses can be prepared in vegetable broth, with the addition of potatoes and cereals, pasta. Meat can be baked, boiled, steamed. But both meat and fish should be only low-fat varieties (chicken, turkey, cod, pike perch, perch). Vegetables should also be grated: pumpkin, potatoes, zucchini, carrots. They are usually used to make mashed potatoes and vegetable stews, which are then grinded. Fruits and berries to eat raw cannot be boiled or baked (for example, apples). Allowed fruit jelly, berry and juices, rosehip drink, tea (only weakly brewed).
Up to 100 grams of protein food per day should be introduced into the diet, but carbohydrate foods should be discarded (sweets and honey). The amount of fat should be at the usual level or decrease (if the patient does not tolerate them well). With this diet, vitamins and preparations containing iron should also be taken. Also, doctors usually prescribe enzyme preparations to activate the digestive processes.
I. D. Maksimova, Candidate of Medical Sciences,
A.F. Loginov, Candidate of Medical Sciences
Stomach cancer continues to be one of the most common cancers. The main method of treating tumors of this localization is surgical. Stomach surgery is a serious intervention that requires careful preparation, carried out not only by the medical staff, but also by the patient and his family.
Preoperative preparation consists in restorative treatment - protein-rich food, a sufficient amount of liquid, vitamins, tonics. And in the presence of a narrowing of the outlet of the stomach and a delay in food masses in it, food is only fed with soft, sometimes pureed food for adequate evacuation from the stomach.
The postoperative period requires no less serious attitude. In the early postoperative period, patients are deprived of the opportunity to take water and food through the mouth. Nutrition is carried out by intravenous administration of nutrient solutions, including protein and amino acid solutions. The body's need for various substances is determined on the basis of a blood test.
During this period, the patient for 2 days prescribe hunger, carry out active aspiration of gastric contents. WITH 3-sut to, if there are no congestion in the stomach, you can give "weak" tea, rosehip decoction, not very sweet compote without berries in small portions (20-30 ml) 5-6 times a day. For the introduction of protein products from the first days, the use of protein enpit is recommended (40 g per glass of water). Usually, in the first 2-3 days, 30-50 g of such a solution is given through a probe, and later, after removal of the probe, through the mouth. The diet is based on the principle of a gradual increase in the load on the gastrointestinal tract and the inclusion of a sufficient amount of protein. The specific type of enteral nutrition should be recommended by your doctor. The use of enpits allows you to bring the amount of animal protein in the diet to the physiological norm, to provide the body with the necessary vitamins and mineral salts.
WITH 3-4 days after the operation, they begin to expand the diet and prescribe slimy soups, meat, fish and curd purees and soufflés, a soft-boiled egg, and with 5-6 days- steam omelets, mashed cereals and vegetable purees in small quantities (50 g per serving). From the 5th day, with good tolerance of such a diet, every meal should already include protein foods. Gradually, the portions of food taken at one time are increased (from 50 ml on the 3rd day to 200 - 250 ml on the 7th day and up to 300 - 400 ml on the 10th day). Thus, in the early postoperative period, patients will receive a sufficient amount of complete protein in an easily digestible form.
A sparing diet is prescribed to patients after 1 - 2 weeks. after surgery for 4 months... In the presence of complications such as gastritis of the gastric stump, anastomosis, peptic ulcer, patients should follow the diet for a longer time. The main purpose of the diet is to prevent or reduce the inflammatory process, to prevent dumping syndrome.
This is a physiologically complete diet with a high protein content (meat, fish), a normal content of complex carbohydrates (cereals, cereals, vegetables, unsweetened fruits) and a sharp restriction of easily digestible carbohydrates (sugar, sweets, confectionery, fruit water, canned juices), with normal fat content, limitation of mechanical and chemical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract, with the maximum limitation of nitrogenous extractive substances (especially purines), refractory fats (lamb), fat breakdown products obtained during frying (aldehydes, acroleins), with with the exception of strong stimulants of bile secretion and secretion of the pancreas and intestinal glands, foods and dishes that cause dumping syndrome (sweet liquid milk porridge, for example, semolina, sweet milk, sweet tea, hot fatty soup, etc.).
The meat is given in chopped form, and the side dishes are not grated (porridge, mashed potatoes). Salads, fresh fruits and vegetables, black bread are excluded. All dishes are boiled, mashed or steamed. The third course for lunch is unsweetened (no sugar) or with the addition of xylitol (10-15 g per serving). The patient is given a strictly limited amount of sugar,
Complex therapy aimed at compensating for the impaired functions of various body systems begins after 2 weeks. after surgery and lasts 2-4 months. Diet is an important part of comprehensive treatment during this period. This is a physiologically complete diet with a high protein content (140 g), normal fat content (110-115 g) and carbohydrates (380 g) with limited mechanical and chemical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract. Refractory fats, extractives, digestible carbohydrates, fresh milk are excluded. Patients should follow a fractional diet. It is necessary to strictly limit the intake of easily digestible carbohydrates in order to avoid the development of hypoglycemic and dumping syndrome. At the same time, prescribing only a protein diet without a sufficient amount of carbohydrates is impractical, because under conditions of restriction of carbohydrates, proteins can be uneconomically consumed to cover energy costs, which leads to an increase in protein deficiency in the body. However, given the loss of peptic factor in such patients, preference should be given to protein products that are easily "attacked" by trypsin - fish and milk. The intake of foods with coarse fiber and a large amount of connective tissue should be limited or they are subjected to heat treatment.
Approximate diet for this period:
- Bread products - wheat bread of yesterday's baked goods, croutons from wheat bread, unpalatable biscuits, slightly sweet. Bread is allowed no earlier than 1 month after the operation.
- Soups - on vegetable, cereal broths, pureed, excluding cabbage and millet.
- Meat and fish dishes - various dishes from lean beef, chicken, turkey, rabbit, veal with tendon removal, lean fish (cod, pike perch, carp, pike, bream, silver hake, carp, ice) in chopped form (mashed potatoes, souffle, dumplings, meatballs, rolls, cutlets). These dishes are boiled, steamed, baked (after pre-boiling).
- Eggs and egg products - soft-boiled egg, no more than one per day, protein omelette.
- Milk and dairy products - milk with tea and other products or as part of various dishes: if tolerated, whole milk. Kefir is turned on 2 months after the operation. Sour cream only as a seasoning. Non-acidic curd, freshly prepared, pureed.
- Vegetables and herbs - boiled, pureed. Only cauliflower, boiled with butter, stewed squash and pumpkin; carrot, beetroot, mashed potatoes.
- Fruits, berries, sweets - natural fruits in limited quantities.
In the future, even in the absence of signs of illness of the operated stomach, one should within 2-5 years adhere to a fractional diet (4-5 times a day), limit the use of foods and meals containing easily absorbed carbohydrates, fresh milk. The diet should be sufficiently varied, taking into account the individual tolerance of the products. Patients with a good result of the operation and with the observance of a fractional diet, as a rule, do not need drug therapy.
In the presence of symptoms of post-gastro-resection disorders, their treatment can be conservative and surgical. Diet therapy occupies a leading place in the conservative treatment of diseases of the operated stomach. Food should be varied, high-calorie, high in protein, vitamins, normal fat and complex carbohydrates, with a sharp restriction of simple carbohydrates. You should also take into account the individual tolerance of foods and dishes. Patients usually tolerate boiled meat, low-fat sausage, cutlets from low-fat meat, fish dishes, soups on weak meat and fish broths, dairy products, vegetable salads and vinaigrette seasoned with vegetable oil. Sugar, milk, sweet tea, coffee, compote, honey, sweet liquid milk porridge, pastries made from butter dough, especially hot ones, are worst tolerated. Food intake should be fractional, at least 6 times a day.
In case of dumping syndrome, it is recommended to start eating with dense meals; after eating, it is advisable to lie in bed or recline in a chair for 30 minutes. The products are used unprocessed, their chemical composition and energy value are 138 g of protein, 110-115 g of fat, 390 g of carbohydrates, the total energy value is 3000 kcal. The fractional diet - 5-6 times a day. In terms of the set of products, the diet is significantly different from the pureed one.
- Bread products - wheat gray bread, yesterday's baked goods, unpalatable and unsweetened varieties of baked goods and biscuits. Seeded rye bread.
- Soups - vegetable broths and cereals, vegetarian. Borscht, cabbage soup, fresh cabbage beetroot. Low-fat meat soup once a week.
- Meat and fish dishes - various products from lean beef, chicken, turkey, rabbit, veal, lean fish (cod, pike perch, carp, navaga, pike, carp, etc.). These products are boiled, baked, stewed; can be cooked in a slice.
- Eggs and dishes from them - soft-boiled egg, no more than 1 per day, protein omelet.
- Cereals and pasta - crumbly and viscous cereals, puddings, casseroles from cereals - unsweetened; boiled pasta and in the form of casseroles. Buckwheat, oatmeal and rice porridge are recommended, semolina is limited.
- Vegetables and greens - raw, boiled, baked, stewed. Allowed non-acidic sauerkraut, cauliflower boiled with butter, stewed zucchini and pumpkin, salads, vinaigrette, green peas. Tomatoes with vegetable oil. Early raw, finely chopped greens can be added to various dishes.
- Fruits and berries, sweet and sugary foods - not very sweet fruits and berries in their natural form and in the form of unsweetened compotes, jelly, mousses. Limit grapes and grape juice, which causes bloating. Sugar, honey, candy, jam are extremely rare.
- Milk and dairy products - milk with tea and other drinks or as part of various dishes, if tolerated - whole milk, yogurt, kefir, acidophilus milk. Sour cream as a seasoning and in salads. The curd is non-acidic, fresh.
- Fats - butter, ghee, olive oil, sunflower oil.
- Snacks - mild cheese, low-fat herring, doctor's sausage, diet sausages, homemade meat pâté, ham without lard. Salads, vinaigrette, jellied fish on gelatin, jelly from boiled legs on gelatin.
- Sauces and spices - on vegetable broth, sour cream, with the addition of butter.
- Drinks and juices - "weak" tea, weak coffee with milk, unsweetened, fruit and berry, vegetable juices, rosehip decoction.
It is forbidden to use the same foods and dishes as when prescribing a pureed diet, except for white cabbage.
Approximate one-day menu when using an unprocessed diet:
1st breakfast: boiled meat, salad of tomatoes and cucumbers with sour cream, oatmeal porridge without sugar, tea with milk.
2nd breakfast: cheese 50 g, apple.
Dinner: vegetarian borscht, boiled meat stew with mixed vegetables, xylitol jelly.
Afternoon snack: boiled fish, boiled beets.
Dinner: meat soufflé, stewed carrots, cheesecake with cottage cheese without sugar.
At night: a glass of kefir, fresh cottage cheese 100 g.
All day: rye bread - 150 g, white bread - 150 g, sugar - 30 g.
All meals should be boiled or steamed and not grated. Separate baked dishes without a coarse crust are allowed, the third dish for lunch is savory or xylitol (10-15 g per serving). Sugar is given to the patient in a strictly defined amount.
Drug therapy for dumping syndrome is significantly less effective, so sensible dietary advice is more beneficial.
Dumping syndrome (from the English dumping - dropping), dropping syndrome is one of the leading post-resection disorders. It occurs in some patients after partial or complete removal of the stomach due to a violation of the nervous and enzymatic regulation of the organs involved in digestion. As a rule, there is an accelerated evacuation ("dumping") of food from the stomach stump into the intestine, impaired carbohydrate metabolism and the function of the rest of the stomach. The attack begins after eating (more often after taking easily digestible food rich in carbohydrates) and is manifested by a sharp general weakness (sometimes with a disorder of consciousness), dizziness, profuse sweating, increased heart rate and decreased blood pressure, drowsiness, belching, regurgitation or vomiting, pain in the stomach.
Nutrition after gastric resection should be adjusted as after removal or resection of the stomach, food flows excessively quickly from the esophagus and the remainder of the stomach into the small intestine, where essential nutrients are absorbed. In this case, the patient may experience a feeling of heaviness in the epigastric region soon after eating, general weakness, sweating, dizziness, increased heart rate, dry mouth, bloating, drowsiness, desire to lie down.
These phenomena are most often observed after eating, especially after eating sweet and hot food, and are defined as dumping syndrome. Proper nutritional management helps to avoid complications.
Following gastric resection, the following nutritional guidelines must be observed
- strictly adhere to the diet
- eat often - 5-6 times a day, due to the fact that the stomach has decreased in volume (during resection).
- food should be taken slowly, chewing thoroughly.
- limit foods and meals containing easily and quickly digestible carbohydrates;
- these are, first of all, sweets - sugar, honey, jam, sweet milk porridge, sweet tea. It is these foods that are the most common cause of poor health.
- It is advisable to consume the third dish not immediately, but 0.5-1 hours after eating, so as not to overload the stomach. This applies to tea, milk, compote for lunch, milk and kefir after dinner. The amount of liquid for 1 dose should not exceed 200 ml.
- It is very important that food after stomach surgery is tasty, varied, and includes all the main nutrients. Particular importance is attached to complete animal proteins (lean meat, chicken, fish, eggs, cottage cheese, cheese) and vitamins (vegetable dishes, fruits, berries, vegetable and fruit juices, rosehip decoction, other vitamin drinks).
The emphasis on nutrition should be made in the first 2-3 months after the patient is discharged from the hospital: it is at this time that the digestive system and the body as a whole adapt to new conditions in connection with the operation.
Diet therapy tactics can be schematically represented in this way. In the first 2-3 months after the operation, it is recommended to eat at least 6 times a day, mainly chopped meals and pureed steamed foods. In fact, the same diet is recommended as for peptic ulcer disease (dietary table No. 1, pureed version).
However, it is necessary to limit the consumption of sweets. After 2-3 months, the doctor may recommend a non-rubbed version of dietary table No. 1. In 3-4 months after the operation, dietary table No. 1 or No. 5 is allowed.
Specific dietary recommendations
, relating to the first 2-3 months after the operation, are reduced to the following.
Nutrition in the first days after gastric resection
- 1st day: the patient does not receive food.
- 2nd day: weak tea, fruit not very sweet jelly, mineral water- 30 ml every 3-4 hours.
- 3rd and 4th day: 1st breakfast - a soft-boiled egg, half a glass of tea or a steam omelet; 2nd breakfast - juice, jelly or mineral water, mashed rice porridge; lunch - slimy rice soup with meat puree or creamy meat soup; afternoon tea - tea or rosehip broth; dinner - cottage cheese or meat soufflé; at night - unsweetened fruit jelly - 1/2 cup.
- 5th and 6th days: 1st breakfast - soft-boiled egg, or steam omelet, or meat soufflé, tea with milk; 2nd breakfast - grated rice or grated buckwheat porridge; lunch - mashed rice soup, steamed meat soufflé; afternoon tea - sugar-free cottage cheese soufflé; dinner - steamed meat dumplings, carrot puree; at night - fruit jelly without sugar.
- 7th day: 1st breakfast - 2 soft-boiled eggs, liquid rice or buckwheat porridge, tea; 2nd breakfast - cottage cheese steam soufflé without sugar; lunch - mashed rice soup with potatoes, steamed meat cutlets, mashed potatoes; afternoon tea - fish steamed soufflé; dinner - calcined cottage cheese, jelly. White bread rusks are allowed.
A week after the surgery, diet No. 1 is prescribed, a pureed version with a restriction of easily absorbed carbohydrates (primarily sugar and sweets).
- soups: on vegetable broth with various grated cereals, vegetables, pasta;
- meat and fish dishes: from lean meat, poultry (chicken, turkey) and fish (cod, hake, ice, navaga, pike perch, carp, perch) - boiled or steam. Meat mainly in the form of cutlets, dumplings, meatballs, mashed potatoes, soufflé;
- vegetable dishes: potatoes, carrots, beets, cauliflower, pumpkin, mashed zucchini, steamed soufflés and puddings;
- cereals and pasta: pureed milk porridge (rice, oatmeal, pearl barley, barley, buckwheat); oatmeal porridge "Hercules", soufflé, puddings from grated cereals; dishes from noodles, pasta, homemade noodles;
- egg dishes: soft-boiled egg, steam omelet;
- milk and dairy products: whole milk, dry, condensed without sugar (added to the dish), sour cream, cream, freshly prepared cottage cheese;
- fruit and berry: ripe fruits and berries - boiled, mashed or baked;
- sauces: milk, sour cream, fruit;
- snacks: mild cheese, low-fat ham;
- sweets: honey, jams, preserves, marshmallows, marshmallows in limited quantities, subject to good tolerance;
- drinks: weak tea with milk or cream, weak coffee with milk or cream;
- jelly and juices: fruit, berry (not very sweet), vegetable juices, rosehip decoction;
- fats: butter, ghee, vegetable (added to ready-made dishes);
- bread and bakery products: wheat, slightly dried, uncooked biscuits; crackers.
Excluded from the diet after gastric resection
- meat, fish, mushroom broths;
- fatty meats, poultry (duck), fish;
- all fried foods, pickles, smoked meats, marinades, hot snacks, pastry, pies, raw vegetables and fruits, not mashed, radishes, rutabagas.
Surgeons remove the fourth, third, or second part of the stomach, less often a complete gastrectomy is performed. The segment of the organ remaining after the operation takes over all the functions, but full-fledged digestion is out of the question. Diet after gastric resection for cancer helps to quickly adapt to the new condition.
Nutrition in the early days
Immediately after the operation, the patient can neither eat nor drink. All the necessary substances must be injected into a vein 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 permits the use of warm sweet tea in small portions (literally a teaspoon each). At the same time, a special liquid food is introduced into the diet - a protein mixture that is easily absorbed and does not irritate the stomach.
Both the process of feeding the patient and the menu in the first days after stomach surgery is the concern of the medical staff. First, food is introduced into the digestive tract through a tube, after removal, in the usual way. In order for recovery after gastric resection in oncology to go without complications, in matters of patient nutrition, it is necessary to strictly follow the instructions of the surgeons.
Diet after surgery
On 4-6 days (everything is determined by the peculiarities of the course of the postoperative period), the patient is transferred to a regular diet. However, the word "usual" does not mean a return to the usual diet, but just a transition to the use of dietary food. The first stage of this transition period is diet No. 0 (A, B, C), which is indicated after any resection of the stomach: regardless of whether it was oncology or an ulcer.
No. 0A
The operated patient should eat often (at least 8 times a day), in portions not exceeding 200 ml. All food should be warm, liquid, and not nearly salty. The duration of this diet is determined by the doctor, depending on the patient's well-being. However, in most cases it is 3 days.
It is allowed to the patient:
- slimy broth of oatmeal or rice;
- low-fat meat broth;
- jelly;
- rosehip infusion slightly sweetened.
No. 0B
Diet No. 0B after stomach surgery for oncology resembles the previous version, but there are also changes in it:
- the frequency of meals can be reduced to 6-7;
- the size of one serving is increased to 250 ml;
- slimy broth can be mixed with grated porridge;
- a little grated dietary meat or chopped egg yolk can be added to the broth.
It is advisable to eat according to these principles for 2-3 days or longer, if there are indications.
No. 0B
This is the final stage in the transition of the operated patient to a complete diet. There should be 5-6 meals a day. The menu can include:
- protein omelet;
- puree soup (vegetable or meat);
- low-fat cottage cheese with cream;
- fermented milk drinks;
- baked apples (non-acidic varieties);
- crackers or biscuits (50-75 g).
Dumping Syndrome
This syndrome is a common complication after gastric cancer surgery. It occurs due to the ingestion of undigested carbohydrate food in the intestines and excessive rush of blood to the duodenum.
The main manifestations: a feeling of fullness in the abdomen, attacks of severe weakness and fever after eating, even loss of consciousness is possible. If the patient does not follow the diet after surgery for stomach cancer, the risk of developing dumping syndrome increases significantly.
To prevent the occurrence of this complication, you must:
- eat more protein foods and complex carbohydrates;
- it is desirable 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
In 10-14 days after surgery on the esophagus and stomach, patients begin to feel much better, but this does not mean that you can not follow the diet. At this stage of the recovery period, diet number 1 is shown. The food should continue to be mashed or pureed, it is necessary to eat 5-6 times a day for 250 g. You can drink no more than a glass of liquid at a time.
It is very important that the patient gets enough protein. To do this, the diet should include protein omelets, lean fish, dietary meat, low-fat cottage cheese. Vegetables and fruits should be steamed or boiled and chopped so as not to irritate the digestive tract.
Meals after a few months
When resection of the stomach, carried out for cancer, the restoration of the functioning of the gastrointestinal tract takes a long time, so food should remain dietary even a few months after the operation. The patient must continue to follow the principles of diet number 1, but can already eat food in pieces. It is preferable to cook dishes by boiling, stewing and baking.
6-8 months after gastric resection, the patient's menu can be like everyone else's. However, it is very important not to forget about the regime - you need to eat often and little by little. In addition, a person who has had stomach cancer and such a complex operation should not risk his health and eat junk food, and even more so drink alcohol.
Allowed Products
What can you eat after stomach removal surgery? Much - the patient's diet may well be useful, varied and tasty.
Doctors refer to approved products:
- porridge (rice, oatmeal, buckwheat);
- chicken, turkey, rabbit, veal;
- hated meat broths;
- fish (hake, cod, pike perch, pollock);
- omelets 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 foods
Errors in nutrition after gastric resection can cause severe pain and indigestion. 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 cereals (corn, pearl barley);
- sausages and smoked products;
- canned food;
- vegetables in which coarse fiber (especially cabbage, radish);
- legumes;
- pickles;
- mushrooms;
- whole milk;
- ice cream, sweets;
- soda, store juice;
- strong coffee and tea;
- sauces.
Sample menu for a week
The menu for a week of a person who underwent gastric resection, 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 - a baked apple, a glass of kefir. Dinner - scrambled eggs, boiled fish, tea.
- Tuesday. Breakfast - buckwheat porridge, tea. 2nd breakfast - cherry jelly, two croutons. 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 - soup with meat and cereals, a slice of fish, bread. Afternoon snack - berry jelly, toast. Dinner - mashed potatoes, meat pâté (homemade), tea. At night - a glass of yogurt.
- All subsequent days, you can alternate the indicated dishes.
The duration and nature of the recovery period after excision of a part of the stomach depends to a large extent on how the patient eats. The doctor, when composing a diet for such a patient, takes care that the operated organ first heals well, and only then learns to re-digest the gastric contents.
Useful video about life after gastric resection
- Efficiency: therapeutic effect after 3-4 months
- Timing: up to 6 months
- Products cost: 1050-1150 rubles per week
- General rules
- Indications
- Allowed Products
- Advantages and disadvantages
- Reviews and results
- Diet price
General rules
Resection of the stomach or its part in a number of cases is the only possible method of treatment and saving the patient's life. Stomach surgery is a radical treatment for extensive malignant neoplasms ( stomach cancer), not amenable to conservative treatment stomach ulcers, polyps, stomach bleeding. Despite the progress of medicine, gastric removal remains one of the most difficult surgical operations, and even if it is successful and there are no pronounced complications, rehabilitation takes a long period of time, and nutrition after stomach surgery is the most important component of this process.
Diet after resection of the stomach or after removal of part of the stomach
Parenteral nutrition after gastric resection begins with sequential Diet number 0A, 0B, 0V (1A, 1B, 1B surgical). Their purpose is to provide the patient's body with a minimum amount of basic nutritional nutrients, unload and sparing the stomach, prevent intestinal bloating and flatulence... The diet contains easily digestible foods containing complete proteins, fats, carbohydrates, vitamins and macro / micronutrients and an increased amount of free fluid. The use of salt is sharply limited.
On the first postoperative day, the patient is shown hunger; on the 2nd day - the diet includes 250 ml of warm sweet tea and rosehip infusion (50 ml), which are given after 15-20 minutes in a teaspoon; for 4-5 days in the absence of bloating and normal peristalsis, appoint Diet number 0A and 2 soft-boiled eggs; for 6-8 days Diet number 0B; for 9-11 days - Diet number 0B.
- Diet number 0A... Contains 5-10 g of proteins, 15-20 g of fat and 180-200 g of carbohydrates. The volume of free liquid is at the level of 1.8-2.2 liters, sodium chloride is not more than 1-2 g. The energy value of the daily diet varies within 760-1020 Kcal. Food is served liquid. Fractional diet - up to 7-8 times a day and the volume of food for one meal is not more than 250 g. The diet includes slimy decoctions with cream, light low-fat meat broth, fruit and berry jelly / jelly, sweet rosehip decoction, fruit and berry juices ... Dishes of puree and dense consistency, drinks containing carbon dioxide, whole milk are completely prohibited.
- Diet number 0B... Contains 40-50 g of proteins, 50 g of fat and 250 g of carbohydrates. The volume of free liquid is up to 2 l / day, sodium chloride is not more than 4-5 g. The energy value of the daily diet is 1580-1650 Kcal. Food is prepared in liquid / puree form. Diet - up to 6 times a day, portion size should not exceed 400 g. In addition to permitted foods Diet number 0A the diet expands due to the addition of slimy cereal soups cooked with vegetable broth, soft-boiled eggs, liquid mashed rice and buckwheat cereals, protein steam omelets, dietary meat and fish puree, sweet berry jelly.
- Diet 0B... It is a transitional diet to the subsequent physiologically complete nutrition. Contains 80-90 g of protein, 70 g of fat and 320 g of carbohydrates. The volume of free liquid is 1.5 l / day. Sodium chloride is not more than 6-7 g. The energy value of the daily diet is 2100-2400 Kcal. Food is served puree. Diet - 5-6 times a day. The diet additionally includes cream soups / mashed potatoes, mashed meat and steamed fish, cottage cheese grated with cream, sour milk drinks, baked apples, mashed fruit / vegetable purees and 50-75 g of white bread crumbs.
The duration of each of the surgical diets is 2-4 days, but, if necessary, the time spent on them can be lengthened or shortened. That is, approximately, after 9-12 days, the surgical diet after the operation ends, and the patient is transferred to the standard Diet number 1 according to Pevzner (mashed version), which limits the amount of food consumed in one meal: no more than 250 g of the first mashed dish or a glass of liquid (250 g), and at lunchtime - only two dishes. Food intake is fractional, 5-6 times a day.
The diet contains an increased amount of protein (100-110 g), which is used as dishes from boiled chopped meat, boiled fish, fresh mashed / calcined cottage cheese, omelettes from egg whites. The amount of fat in the diet is at the level of physiological norms or several times higher (80-90 g). If the patient does not tolerate fats (and in its pure form too), which is manifested by bitterness in the mouth, regurgitation, diarrhea, their number is limited to 60-70 g. The carbohydrate content is reduced to 300-320 g due to easily digestible carbohydrates.
In a number of cases, in particular when dumping syndrome manifested dizziness, weakness, heartbeat chills, fever, abdominal pain and bloating, diarrhea that appear after a meal, it is necessary to completely exclude foods containing sugar, since the use of easily digestible carbohydrates is one of the reasons for its occurrence.
To slow down the evacuation of food from the stomach stump, it is recommended to use viscous and jelly-like dishes. You can practice separate meals of a dense and liquid consistency, starting with a dense one, as well as eating while lying down. Eating food in even small portions 6-7 times a day. After eating, you need to lie / lie in bed for 30-40 minutes. You can also practice before eating carbohydrate food, the use of butter, which inhibits the excretion of food from the gastric stump. If whole milk is poorly tolerated, it is excluded from the diet and replaced with other products.
Strong broths based on meat, mushrooms and fish, fatty red meat and fish, some types of birds (duck, goose) and products based on them (sausages, canned food, ham, smoked meats), fried foods, dough products are completely excluded from the diet. , fresh bread, hot snacks, salted fish and vegetables, solid animal fats, raw vegetables and fruits that are not pureed.
If the patient feels well, 3-4 months after the operation, he is gradually transferred to the not shabby version. Diets number 1... The diet is physiologically complete, contains an increased amount of proteins and an almost normal amount of fats and complex carbohydrates. The restriction applies to simple carbohydrates in order to prevent the development of dumping syndrome. The culinary methods of processing food are preserved: the food is boiled or steamed, and after boiling, it is baked or stewed. In terms of the set of products, the diet of this diet option is more extensive, but the rules and restrictions are the same.
Allowed the use of low-fat meat soups, borscht, cabbage soup (once a week), dried wheat bread, low-fat varieties of fish and beef, chicken dishes, non-nutritious cookies. It is allowed to eat boiled and raw vegetables, garden herbs, fermented milk products, dishes based on buckwheat and rice, potatoes, mild low-fat cheese, diet varieties of sausages, fresh fruits and berries.
In the absence of complications and satisfactory function of the gastrointestinal tract, 6 months after the operation, the patient can switch to a normal diet, but taking into account the diet and the characteristics of the chemical composition of the diet. It is possible to independently correct the set of food products in the diet, taking into account individually intolerable products. With a pronounced loss of body weight (by 10-15%) after gastric resection, especially for cancer, the caloric content of the daily diet should be increased compared to the physiological norm by increasing the content of the main food nutrients recommended for the diet.
When complications such as inflammation of the anastomosis or gastric stump occur, peptic ulcer prescribe a rubbed version Diets number 1, and during exacerbation - sequentially No. 1A and 1B with the introduction of changes in them, taking into account the intolerance of certain products. In general, the nutrition of patients with diseases of the operated stomach must be individualized.
It is advisable to include specially developed dietary nutritional mixtures in food after stomach surgery - “ Nutrizone», « Nutridrink», « Berlamin Modular», Which should be administered in small portions, can be diluted with water, with a constant assessment of their tolerance.
Diet food must necessarily include taking tablets of a vitamin-mineral complex, drugs that normalize the motor-evacuation function of various parts of the gastrointestinal tract and drugs containing enzymes to improve digestion processes ( Creon, Mezim-forte). Full rehabilitation of patients is long and usually occurs by the end of the first year after surgery.
Indications
Stomach resection and complications of the operated stomach.
Allowed Products
The diet after resection of the stomach when transferring the patient to Diet number 1 (A, B) includes slimy cereal soups from rice, buckwheat, oatmeal with the addition of butter, low-fat cream or egg-milk mixture, cream to the finished dish. For the second courses, low-fat types of red meat (veal, beef), well-boiled chicken or turkey meat are used and passed through a meat grinder.
Allowed dishes from white fish (cod, pollock, pike, hake) in the form of steamed or boiled. Cereal dishes are prepared in milk / water in the form of a liquid porridge made from buckwheat, oatmeal, rice groats, to which butter is added.
With good tolerance, the diet includes milk and dishes based on it, low-fat cream, calcined cottage cheese, milk jelly, chicken eggs in the form of a steam omelet or soft-boiled.
Of the fats, preference is given to butter and vegetable oils, added immediately before use to the finished dish. Useful jelly and jelly from sweet berries. From drinks - juices from fresh berries, weak tea with cream, rosehip infusion.
Approved Products Table
| Proteins, g | Fat, g | Carbohydrates, g | Calories, kcal | |
| buckwheat (unground) | 12,6 | 3,3 | 62,1 | 313 |
| cereals | 11,9 | 7,2 | 69,3 | 366 |
| rice white | 6,7 | 0,7 | 78,9 | 344 |
| white bread crackers | 11,2 | 1,4 | 72,2 | 331 |
| sugar | 0,0 | 0,0 | 99,7 | 398 |
| milk | 3,2 | 3,6 | 4,8 | 64 |
| cream | 2,8 | 20,0 | 3,7 | 205 |
| cottage cheese | 17,2 | 5,0 | 1,8 | 121 |
| boiled beef | 25,8 | 16,8 | 0,0 | 254 |
| boiled veal | 30,7 | 0,9 | 0,0 | 131 |
| rabbit | 21,0 | 8,0 | 0,0 | 156 |
| boiled chicken | 25,2 | 7,4 | 0,0 | 170 |
| Turkey | 19,2 | 0,7 | 0,0 | 84 |
| chicken eggs | 12,7 | 10,9 | 0,7 | 157 |
| butter | 0,5 | 82,5 | 0,8 | 748 |
| mineral water | 0,0 | 0,0 | 0,0 | — |
| black tea with milk and sugar | 0,7 | 0,8 | 8,2 | 43 |
| juice | 0,3 | 0,1 | 9,2 | 40 |
| jelly | 0,2 | 0,0 | 16,7 | 68 |
| rosehip juice | 0,1 | 0,0 | 17,6 | 70 |
Fully or partially limited products
In the patient's diet after surgery on the stomach, bakery and confectionery products, fresh bread, pastries, products from any type of dough are excluded. Strong broths based on meat or fish, dishes from fatty meats and fish, as well as products based on them (canned food, sausages, smoked meats), solid animals and culinary fats, fried foods, pickles, mushrooms, various snacks, vegetables and raw fruits, fatty cottage cheese, cheese, sour cream, dairy products.
You can not include in the diet of various sauces and seasonings, spices. It is forbidden to use drinks with gas, strong tea, coffee, concentrated vegetable and fruit juices, any alcoholic beverages.
Prohibited Products Table
| Proteins, g | Fat, g | Carbohydrates, g | Calories, kcal | |
Vegetables and greens |
||||
| vegetables | 2,5 | 0,3 | 7,0 | 35 |
| legumes | 9,1 | 1,6 | 27,0 | 168 |
| swede | 1,2 | 0,1 | 7,7 | 37 |
| cabbage | 1,8 | 0,1 | 4,7 | 27 |
| green onion | 1,3 | 0,0 | 4,6 | 19 |
| onion | 1,4 | 0,0 | 10,4 | 41 |
| white radish | 1,4 | 0,0 | 4,1 | 21 |
| horseradish | 3,2 | 0,4 | 10,5 | 56 |
| spinach | 2,9 | 0,3 | 2,0 | 22 |
| sorrel | 1,5 | 0,3 | 2,9 | 19 |
Mushrooms |
||||
| mushrooms | 3,5 | 2,0 | 2,5 | 30 |
Cereals and cereals |
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| corn grits | 8,3 | 1,2 | 75,0 | 337 |
| pearl barley | 9,3 | 1,1 | 73,7 | 320 |
| millet groats | 11,5 | 3,3 | 69,3 | 348 |
| barley grits | 10,4 | 1,3 | 66,3 | 324 |
Flour and pasta |
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| pasta | 10,4 | 1,1 | 69,7 | 337 |
Bakery products |
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| bagels | 16,0 | 1,0 | 70,0 | 336 |
| wheat bread | 8,1 | 1,0 | 48,8 | 242 |
Confectionery |
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| jam | 0,3 | 0,2 | 63,0 | 263 |
| candies | 4,3 | 19,8 | 67,5 | 453 |
| pastry cream | 0,2 | 26,0 | 16,5 | 300 |
Ice cream |
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| ice cream | 3,7 | 6,9 | 22,1 | 189 |
Cakes |
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| cake | 4,4 | 23,4 | 45,2 | 407 |
Chocolate |
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| chocolate | 5,4 | 35,3 | 56,5 | 544 |
Raw materials and seasonings |
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| mustard | 5,7 | 6,4 | 22,0 | 162 |
| ginger | 1,8 | 0,8 | 15,8 | 80 |
| ketchup | 1,8 | 1,0 | 22,2 | 93 |
| mayonnaise | 2,4 | 67,0 | 3,9 | 627 |
| ground black pepper | 10,4 | 3,3 | 38,7 | 251 |
| chilli | 2,0 | 0,2 | 9,5 | 40 |
Dairy products |
||||
| sour cream | 2,8 | 20,0 | 3,2 | 206 |
Meat products |
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| pork | 16,0 | 21,6 | 0,0 | 259 |
| Salo | 2,4 | 89,0 | 0,0 | 797 |
Sausages |
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| sausage with / dried | 24,1 | 38,3 | 1,0 | 455 |
| sausages | 12,3 | 25,3 | 0,0 | 277 |
Bird |
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| smoked chicken | 27,5 | 8,2 | 0,0 | 184 |
| duck | 16,5 | 61,2 | 0,0 | 346 |
| smoked duck | 19,0 | 28,4 | 0,0 | 337 |
| goose | 16,1 | 33,3 | 0,0 | 364 |
Fish and seafood |
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| dried fish | 17,5 | 4,6 | 0,0 | 139 |
| smoked fish | 26,8 | 9,9 | 0,0 | 196 |
| canned fish | 17,5 | 2,0 | 0,0 | 88 |
Oils and fats |
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| cream margarine | 0,5 | 82,0 | 0,0 | 745 |
| animal fat | 0,0 | 99,7 | 0,0 | 897 |
| cooking fat | 0,0 | 99,7 | 0,0 | 897 |
Alcoholic drinks |
||||
| white dessert wine 16% | 0,5 | 0,0 | 16,0 | 153 |
| vodka | 0,0 | 0,0 | 0,1 | 235 |
| cognac | 0,0 | 0,0 | 0,1 | 239 |
| beer | 0,3 | 0,0 | 4,6 | 42 |
Non-alcoholic drinks |
||||
| cola | 0,0 | 0,0 | 10,4 | 42 |
| sprite | 0,1 | 0,0 | 7,0 | 29 |
| tonic | 0,0 | 0,0 | 8,3 | 34 |
| black tea | 20,0 | 5,1 | 6,9 | 152 |
| energy drink | 0,0 | 0,0 | 11,3 | 45 |
* data are indicated for 100 g of product
Nutrition menu after gastric resection (Nutrition mode)
The menu for a week after gastric resection should provide alternation of various protein and cereal dishes in order to prevent its monotony, with strict adherence to the permitted methods of culinary processing of products and, most importantly, observance of the portion size. It should be remembered that meat / fish dishes are allowed to be consumed in the form of mashed potatoes or soufflés once a day. If milk is intolerant, it must be replaced with other products or consumed in small portions, as well as diluted with weak tea.
