Diets

Diet after removal of the stomach (gastrectomy)

General rules

Gastrectomy is an operation to completely remove the stomach with the direct connection of the esophagus with the small intestine. The most common indications for gastrectomy are: stomach cancer, diffuse polyposisperforation of the wall of the stomach, launched peptic ulcers with bleeding. If the indication for gastrectomy is cancer, then an extended gastrectomy is performed (at the same time, the omentums, spleen and regional lymph nodes are removed).

As a result, due to the lack of a stomach (an organ of mechanical / chemical processing of food) and the ingestion of food directly from the esophagus into the small intestine, new specific anatomical and physiological conditions for the digestion process are formed in the body.

Adaptation of the body to new nutritional conditions takes a long time (8-12 months) and is often accompanied by complications such as:

  • Reflux esophagitis - inflammation of the esophagus due to the throwing of bile and contents of the jejunum into it.
  • Dumping syndrome: due to the rapid entry of large volumes of insufficiently processed food from the esophagus into the small intestine and is manifested sweatingweakness dizzinesspalpitations, sometimes with a single vomiting after eating.
  • Anemic syndrome.
  • Progressive Weight Loss.

Nutrition after a gastrectomy of the stomach is an essential component of the rehabilitation process. Diet therapy with a remote stomach involves several stages and begins with the sequential appointment of strict surgical diets (0A, 0B, 0B). On the first or second postoperative day, the patient is shown hunger. From 2-3 days the patient is allowed to give weak tea, mineral water, a rosehip broth, slightly sweetened jelly.

If intestinal function does not suffer, from 4-5 days the diet is expanded by vegetable puree soups, soft-boiled eggs, steamed curd soufflé, and buckwheat / rice mashed liquid porridge. For 8–9 days, mashed potatoes and steamed fish balls / meatballs are added to the diet. From 14-15 days the patient is transferred to the wiped version Diet number 1 or 1 surgical.

The most important task of a therapeutic diet for people without a stomach is to overcome the protein and vitamin-mineral deficiency that occurs in most patients due to malnutrition in the first postoperative days, the breakdown of tissue proteins, blood loss and fever. Therefore, starting from 4-5 days, each meal should contain protein products, and the patient needs to be transferred as early as possible to physiologically complete nutrition with the inclusion of a wide range of products, taking into account the body's ability to digest food.

All dishes are steamed / boiled and thoroughly wiped. Preference must be given to protein foods. The diet includes low-fat broth, mashed vegetable soups on cereal broths, dishes of low-fat beef / chicken and fish (pike perch, cod, carp, hake), steam omelet / soft-boiled eggs, milk as a part of dishes. It is allowed to include boiled vegetables in the diet and serve them in the form of mashed potatoes and carrots, cauliflower, stewed zucchini and pumpkin. From cereals (rice, oatmeal, buckwheat), you can cook viscous cereals / casseroles (sugar free).

Vegetable, butter and sour cream can be used only as a seasoning for ready-made dishes. Of fruits, it is recommended to cook jelly / mousse / jelly. Dried bread can be included in the diet no earlier than a month after the operation. Allowed fruit juices, unsweetened tea. Kefir is allowed to drink 1.5-2 months after surgery.

The diet provides for the exclusion from the diet of muffins, pickles, marinades, smoked meats, offal, fatty meats, canned goods, sausages, legumes, chocolate, ice cream, mushrooms, raw vegetables (white cabbage, onions and garlic, radishes, spinach, sorrel), coffee carbonated drinks.

In order to prevent dumping syndrome in the diet, foods containing easily digestible carbohydrates (sugar, honey, jam, sweets) are limited. The assortment / volume of food intake should be expanded gradually. So, in the first two weeks, portions are increased: up to 50 ml on the 3rd day, up to 200/250 ml on the 7th day and up to 300/400 ml on the 10th day. The amount of liquid should not exceed 200 ml at a time.

If the patient has concomitant diseases of the digestive tract (pancreatitis, colitis), then changes are made to the diet. When constipation should be included in the diet boiled beets, vegetable juices, prune broth. After 4-6 months, in the normal condition of the patient, it is allowed to gradually transfer to an uncleaned version of the diet. At the same time, the rules of nutrition, methods of culinary processing of products and restrictions remain the same.

Particular attention is required to nutrition after removal of the stomach for cancer. In this case, preoperative preparation is necessary, including, but not limited to, a high-calorie diet, especially against the background of preoperative / postoperative chemotherapyaccompanied by a persistent decrease in appetite, a change in taste / smell, which contributes to the development of nutritional deficiency.

As a rule, in cancer patients 2-4 degrees already takes place nutritional deficiency (deficiency of BJU, vitamins and minerals), which is due to a sharp acceleration of processes catabolism and inhibition of protein synthesis. Therefore, in the preoperative period, the diet of cancer patients should have a calorie level of 4000-4500 kcal / day, in order to eliminate / reduce protein-energy deficiency if possible.

Modern approaches to the management of cancer patients with nutritional deficiency in the preoperative period suggest the introduction of enteral nutritional mixtures 12-14 days before surgery, if it is assumed that the patient will take less than 60% of the amount of adequate nutrition after surgery for 7-10 days. This allows you to more effectively correct the immune deficiency / nutritional deficiency and prepare the body for surgery and chemoaggression.

Accordingly, in the postoperative period, if the patient is prescribed complete endogenous nutrition, this will lead to a rapid (catastrophic) depletion of the reserves of BJU. Therefore, the diet after removal of the stomach for cancer involves the introduction in the first 24 hours of protein enpit (40 g / per 200 ml of water) of 30-50 g of solution through a naso-intestinal probe instituted for anastomosis, and later, orally, taking into account the energy needs of cancer patients, which averages 25/30 kcal / kg / day, and in cases of severe nutritional deficiency - at least 35 kcal / kg / day.

The choice of nutrient mixture and the duration of its use is determined by the metabolic needs of the patient and the functional state of the gastrointestinal tract. As practice shows, the use of nutrient mixtures enriched in nucleotides, arginine and omega-3 fatty acids allows you to more effectively eliminate food malnutrition and improves the nutritional status of the patient.

Indications

Gastrectomy, complications after removal of the stomach.

Allowed Products

The diet after removal of the stomach includes:

  • Mucous soups from buckwheat, rice, oatmeal with the addition of egg-milk mixture, butter, low-fat cream in the finished dish.
  • Low-fat varieties of red meat (veal / beef), rabbit, chicken / turkey meat well boiled and chopped through a meat grinder.
  • White fish (pike, cod, hake, pollock), steamed / boiled.
  • Cereals in the form of liquid porridge from rice, buckwheat, oatmeal, with the addition of butter.
  • Steam omelet / soft-boiled chicken eggs
  • Boiled / stewed well chopped vegetables (potatoes, carrots, beets, cauliflower, zucchini, pumpkin).
  • Milk and dishes based on it, non-fat cream, calcified cottage cheese, butter / vegetable oil.
  • Juices from fresh berries, rosehip infusion, milk jelly, weak tea with cream.

Approved Product Table

Proteins, gFats, gCarbohydrates, gCalories, kcal

Vegetables and greens

zucchini0,60,34,624
potatoes2,00,418,180
carrot1,30,16,932
beet1,50,18,840
pumpkin1,30,37,728

Cereals and cereals

buckwheat groats (kernel)12,63,362,1313
cereals11,97,269,3366
white rice6,70,778,9344

Bakery products

white bread crackers11,21,472,2331

Confectionery

jelly2,70,017,979
marshmallows0,80,078,5304
paste0,50,080,8310

Raw materials and seasonings

sugar0,00,099,7398

Milk products

milk3,23,64,864
cream2,820,03,7205

Cheeses and cottage cheese

cottage cheese17,25,01,8121

Meat products

cooked beef25,816,80,0254
boiled veal30,70,90,0131
rabbit21,08,00,0156

Bird

boiled chicken25,27,40,0170
turkey19,20,70,084

Eggs

chicken eggs12,710,90,7157

Oils and Fats

butter0,582,50,8748
ghee0,299,00,0892

Soft Drinks

mineral water0,00,00,0-
black tea with milk and sugar0,70,88,243

Juices and compotes

juice0,30,19,240
jelly0,20,016,768
rosehip juice0,10,017,670
* data are per 100 g of product

Fully or partially restricted products

In the diet after removal of the stomach are excluded:

  • Strong (concentrated) broths based on meat / fish, mushrooms.
  • Fresh bread, bakery / confectionery, pastries, dough products.
  • Fatty meat / fish and products based on them (sausages, canned food, smoked meats).
  • Solid culinary / animal fats, fat curd, raw vegetables / fruits, fried foods, mushrooms, pickles, various snacks, fermented milk products, cheese, sour cream.
  • Sauces / seasonings, spices, concentrated vegetable / fruit juices, drinks with gas, strong tea / coffee, alcohol-containing drinks.

Prohibited Products Table

Proteins, gFats, gCarbohydrates, gCalories, kcal

Vegetables and greens

vegetables2,50,37,035
legumes vegetables9,11,627,0168
swede1,20,17,737
cabbage1,80,14,727
sauerkraut1,80,14,419
green onion1,30,04,619
onion1,40,010,441
canned cucumbers2,80,01,316
white radish1,40,04,121
canned tomatoes1,10,13,520
horseradish3,20,410,556
spinach2,90,32,022
sorrel1,50,32,919

Mushrooms

mushrooms3,52,02,530

Cereals and cereals

corn grits8,31,275,0337
pearl barley9,31,173,7320
millet groats11,53,369,3348
barley grits10,41,366,3324

Flour and Pasta

pasta10,41,169,7337

Bakery products

bagels16,01,070,0336
wheat bread8,11,048,8242
rye-wheat bread8,13,442,2222
bran bread7,51,345,2227

Confectionery

jam0,30,263,0263
candies4,319,867,5453
pastry cream0,226,016,5300
dough7,91,450,6234

Ice cream

ice cream3,76,922,1189

Cakes

cake4,423,445,2407

Chocolate

chocolate5,435,356,5544

Raw materials and seasonings

mustard5,76,422,0162
ginger1,80,815,880
ketchup1,81,022,293
mayonnaise2,467,03,9627
ground black pepper10,43,338,7251
chilli2,00,29,540

Milk products

sour cream2,820,03,2206

Meat products

pork16,021,60,0259
fat2,489,00,0797

Sausages

smoked sausage28,227,50,0360
cured / dried sausage24,138,31,0455
sausages12,325,30,0277

Bird

smoked chicken27,58,20,0184
duck16,561,20,0346
smoked duck19,028,40,0337
goose16,133,30,0364

Fish and seafood

stockfish17,54,60,0139
smoked fish26,89,90,0196
canned fish17,52,00,088

Oils and Fats

cream margarine0,582,00,0745
animal fat0,099,70,0897
cooking fat0,099,70,0897

Alcoholic beverages

dessert white wine 16%0,50,016,0153
vodka0,00,00,1235
cognac0,00,00,1239
beer0,30,04,642

Soft Drinks

kvass bread0,20,05,227
cola0,00,010,442
sprite0,10,07,029
tonic0,00,08,334
black tea20,05,16,9152
energy drink0,00,011,345
* data are per 100 g of product

Food menu after resection of the stomach (Diet)

The food menu is built on the basis of the list of allowed / prohibited foods with strict adherence to the allowed methods of culinary processing of foods, recommendations on the volume of servings and diet.

Advantages and disadvantages

prosMinuses
  • Provides the body with the necessary nutritional nutrients.
  • Creates the continuity of diets and the preparation of the body for new nutritional conditions.
  • Knowledge of cooking techniques for diet foods is required.
  • A long period (up to a year) of being on a diet.

Feedback and Results

Clinical nutrition after gastrectomy, as evidenced by patient reviews, is an essential component of treatment in the postoperative period. The recovery process, the timing of rehabilitation and the course of the postoperative period depend on its proper organization / compliance.

  • "... Cancer of the stomach 3 degrees. Operated - removed the stomach, and underwent 2 courses of chemotherapy. The condition after the operation was serious. They fed through a probe with special mixtures. After 8 days, he began to eat in parallel and was very limited in eating. He started with mucous soups, grated rice porridge, semi-liquid cottage cheese, jelly. Gradually, poultry meat in the form of minced meat, steam omelettes were included in the diet. Now (2 months have passed already) transferred to the wiped Diet No. 1. The wife steams everything or boils it and grinds it very carefully. I still use enteral mixtures, as there is still a 4.8 kg weight deficit. I hope to recover at least a little, the main thing is that there is no tumor recurrence".

Diet price

The diet after gastrectomy contains affordable / inexpensive foods. However, in addition to the grocery set, enteral mixtures are recommended, which additionally affects costs. On average, the cost of products / mixtures varies between 1800-2000 rubles per week.

Watch the video: How to eat after surgery for cancer of the oesophagus or stomach (February 2020).

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