Nutrition after stomach surgery for oncology: features, choice of products, menu. Diet after gastrectomy: how much you can eat, menu at different stages of recovery Diet after gastrectomy

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Stanislav asks:

What should be the nutrition after gastric resection for cancer?

After removal of the stomach, the principle of fractional nutrition should be observed, when food is eaten often, 5 to 6 times a day in small portions. At the same time, at one time you can not eat more than two dishes and one glass of liquid. Milk should be drunk diluted with water so as not to provoke increased bile secretion, followed by nausea and vomiting. It is also absolutely necessary to limit carbohydrate foods (flour, potatoes, cakes, pastries, sweets, chocolate, sugar, etc.) in order to avoid dumping syndrome, which is manifested by the development of sweating, weakness, palpitations, chills and cold sweat after eating. . In addition, the minimum amount of salt should be consumed in the first two months after the operation to remove the stomach. Ready 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 use with a resected stomach:

• Black bread;


• Baking from white flour of the highest grade;


• Sweets (chocolate, cocoa, honey, jam, sweets, cakes, pastries, etc.);


• Sweet drinks;


• Sparkling water;


• Fresh milk;


• Ice cream;


• Fats of animal origin (lard, fat tail, butter, fatty sour cream, etc.);


• Fatty varieties of fish and meat (pork, duck, fatty lamb, salmon, sturgeon, herring, mackerel, etc.);


• offal (liver, kidney, lung);


• Any canned food (meat, fish, vegetable, fruit);


• Smoked meats, pickles;


• Sausages and sausages;


• Mushrooms in any form;



• Vegetables with coarse fiber (white cabbage, radish, turnip, bell pepper, spinach, sorrel, etc.);


• Alcohol;


• Strong coffee .

After removal of the stomach for cancer, the diet consists of several stages. Within 1 - 2 weeks after the operation, it is necessary to follow a strict wiped postoperative diet. Then, for 2 to 4 months, you should follow a pureed diet. After that, an unmashed diet No. 1 is prescribed for another six months, in which chemical irritants for the digestive tract are limited. If the restoration of digestive functions is successful, then a year after the operation, you can switch to a normal diet, when you can eat both cold and hot. However, the restriction on the amount of food taken at a time remains. You will also have to come to terms with the ban on the consumption of sweet, starchy and fatty foods.

So, immediately after the operation, the diet consists of mineral water, slightly sweetened jelly and weak tea. After 2 - 3 days, a rosehip broth, soup-puree from vegetables, liquid pureed cereals on water from rice or buckwheat groats, as well as steamed curd soufflé are introduced. By the 8th - 9th day after the operation, mashed potatoes, meatballs, steamed fish meatballs are introduced.

After that, for 2-4 months, a 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 digestive tract after surgery. All dishes are steamed or boiled and then wiped. On a pureed diet, you can eat vegetable puree soups on a decoction of cereals, low-fat broth, chicken meat, lean beef and fish (cod, pike perch, carp, pike) in chopped form. Soft-boiled eggs and steam omelettes are also allowed. Milk and sour cream can be added to ready meals as seasonings. In addition, you can eat boiled vegetables - cauliflower, zucchini, pumpkin, potatoes, carrots, broccoli, beets, kohlrabi, etc. Viscous pureed porridges on the water are prepared from cereals. Vegetable and butter are used as seasoning in ready meals.

Bread should be yesterday's or lightly toasted from whole grain or bran flour. However, bread and yogurt 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.

Then, for 8-10 months, a person is transferred to a non-mashed diet, which must be observed for a year after surgery to remove stomach cancer. In this diet, all restrictions remain the same, but dishes can be cooked not only for a couple, but also for 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. Bread can still be eaten yesterday from rye, wheat and rye-wheat flour. Non-bread cookies (biscuits, oatmeal, etc.), various chicken dishes, lean meats and fish are also allowed. Vegetables can be consumed not only boiled, but also boiled, and raw, and stewed, and baked. During this period, it is allowed to eat fresh herbs and tomatoes seasoned with vegetable oil. With tolerance, you can drink kefir, milk, acidophilus and yogurt. Cereals, puddings, casseroles are prepared from cereals. From cold snacks, you can eat boiled sausage, sausages, caviar, mild and low-fat cheeses, lean ham, berries and fresh fruits.

Such a diet will have to be followed throughout life, adhering to restrictions on the amount of food taken at a time, as well as the use of flour, sweet and fatty foods.

Cancer in the fourth stage can still be cured! Nutrition according to Shatalova and Moerman

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Feb-18-2017

What is a gastrectomy

A gastric resection is an operation in which a significant part of the stomach is removed, usually from a quarter to two thirds. Basically, resection is performed when various dangerous diseases of the stomach (tumors, ulcers) occur, and the operation can also be performed as a means of combating serious forms of obesity. The first resection was performed in 1881 by Theodor Billroth, this German surgeon also implemented the two main known methods of gastric resection, followed by the restoration of the functioning of the patient's digestive processes. In addition to the methods of the Billroth operation, since the 2000s, methods of gastric resection have been known that do not affect the direct fundamental anatomical functionality of the organ - longitudinal or vertical resection.

In fact, resection is carried out by excising the affected area of ​​the stomach, followed by restoring the state of healthy continuity of the gastrointestinal tract. Continuity is recreated by making a connection between the stomach stump and the jejunum or duodenum by anastomosis.

Resection is complicated in that it affects one of the central elements of the body's supply of resources - the digestive system. A person cannot not eat, so the right diet is very important for an adequate operation and the subsequent recovery process, which, ultimately, has the greatest impact on the possibility of optimal recovery of stomach functions after resection. Immediately before the operation (from a month to a week), it is necessary to strengthen the stomach through a diet - take vitamins and tonics, eat protein-rich foods in order to prepare the stomach and the body in general for stress. An even more serious approach requires a postoperative diet, which is divided into several periods. In the first days after the operation, the patient should be prescribed fasting, then, for some time, food will be provided, of course, in the hospital, through droppers, then through a tube. Subsequently, the doctor will prescribe a diet distributed over several periods.

After these operations, food very quickly comes from the esophagus and the remaining part of the stomach (with its resection - partial removal) into the small intestine, in which the main nutrients are absorbed. At the same time, soon after eating, the patient may experience a feeling of heaviness in the epigastric region, weakness, sweating, dizziness, palpitations, dry mouth, bloating (flatulence), drowsiness, and a desire to lie down.

These phenomena are defined as dumping syndrome. Proper nutrition helps to avoid complications.

Diet after gastrectomy

Those who have undergone gastric surgery must observe the following rules:

1. Eat often, 5-6 times a day, little by little. Eat slowly, chewing thoroughly.
2. Limit the use of foods and dishes containing easily and quickly absorbed carbohydrates, especially sugar, honey, jam, sweet milk porridge, sweet tea.

It is advisable to take the third dish not immediately, but 1/2–1 hour after dinner, so as not to overload the stomach. The amount of liquid at one time should not exceed 200 ml.

Particular attention should be paid to nutrition in the first 2–3 months after discharge from the hospital: it is at this time that the digestive system adapts to new conditions in connection with the operation.

It is very important that the food after stomach surgery is tasty, varied, and includes all the main nutrients. Particular importance is attached to complete animal proteins (found in lean meat, chicken, fish, eggs, cottage cheese, cheese) and vitamins (included in vegetable dishes, which are constituent elements of fruits, berries, vegetable and fruit juices, rosehip broth, etc. ).

Particular attention should be paid to nutrition in the first 2-3 months after discharge 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.

The tactics of diet therapy can be schematically represented as follows. In the first 2-3 months after the operation, it is usually recommended to eat at least 5 times a day, using mostly chopped dishes and foods that have been pureed or steamed. In fact, the same diet is recommended as for peptic ulcer (dietary table No. 1, “wiped” option). However, you need to limit sweets. After 2–3 months, the attending physician may recommend an “unworn” version of the dietary table No. 1. After 3–4 months after the operation, the dietary table No. 5 is allowed.

Therapeutic nutrition in the first days after gastric resection:

1st day. The patient does not receive food.

2nd day. Weak tea, fruit jelly, mineral water (30 ml every 3-4 hours). Kissels are not very sweet.

3rd and 4th day. 1st breakfast - soft-boiled egg or steam omelet, half a glass of tea; second breakfast - juice, or jelly, or mineral water, mashed rice porridge. Lunch - slimy rice soup with meat puree or meat cream soup. Snack - tea or rosehip broth. Dinner - cottage cheese or meat soufflé. At night - unsweetened fruit jelly (1/2 cup).

5th and 6th day. Breakfast - soft-boiled egg, or steam omelet, or meat soufflé, tea with milk. The second breakfast is mashed rice or mashed buckwheat porridge. Lunch - mashed rice soup, steamed meat soufflé. Snack - cottage cheese soufflé without sugar. Dinner - steamed meat dumplings, carrot puree. At night - fruit jelly without sugar.

7th day. Breakfast - 2 soft-boiled eggs, liquid rice or buckwheat porridge, tea. The second breakfast is cottage cheese steam soufflé without sugar. Lunch - mashed rice soup with potatoes, steamed meat cutlets, mashed potatoes. Snack - fish steam soufflé. Dinner - calcined cottage cheese, kissel. White bread crackers are allowed.

A week after the surgery, diet No. 1 is prescribed, a “wiped” option with a restriction of easily absorbable carbohydrates.

• soups on vegetable broth with various pureed vegetables, pasta or cereals;
• dishes from low-fat varieties of meat, poultry (chicken, turkey) and fish (cod, hake, ice, saffron cod, pike perch, carp, perch) boiled or steamed. Meat is mainly in the form of cutlets, dumplings, meatballs, mashed potatoes, soufflé;
• dishes from potatoes, carrots, beets, cauliflower, pumpkins, zucchini, mashed in the form of mashed potatoes, soufflés or puddings;
• milk porridges (rice, oatmeal, barley, buckwheat, "Hercules"), soufflé, puddings from mashed cereals, dishes from vermicelli, pasta, homemade noodles;
• soft-boiled egg, steam omelet;
• whole, dry, condensed milk without sugar (added to the dish), sour cream, cream, freshly prepared cottage cheese;
• fruits and berries boiled, pureed or baked;
• mild cheese, low-fat ham;
• honey, jams, marshmallows, marshmallows in limited quantities, subject to good tolerance;
• weak tea with milk or cream, weak coffee with milk or cream;
• fruit, berry (not very sweet), vegetable juices, rosehip broth;
• butter, ghee, vegetable oil (added to ready meals);
• slightly dried wheat bread, lean cookies, crackers.

Meat, fish, mushroom broths, fatty meats, poultry (ducks), fish, all fried foods, pickles, smoked meats, marinades, spicy snacks, pastry, pies, raw unmashed vegetables and fruits, radishes, rutabaga are excluded from the diet.

Approximate diet menu after gastric resection ("wiped" option):

Breakfast: soft-boiled egg, buckwheat, rice or Hercules porridge, coffee with milk.

Second breakfast: baked apple, rosehip broth.

Lunch: vegetarian potato soup, meat steam cutlets with milk sauce, pureed fresh fruit compote or jelly.

Afternoon snack: milk, biscuits lean.

Dinner: boiled fish and potatoes.

At night: kefir or weak tea with milk.

3 to 4 months after gastric surgery, the "unmashed" diet #1 or #5 is usually allowed.

• soups on vegetable broth with various cereals, vegetables, pasta, beetroot soups, milk soups with cereals, fruit soups with rice. Low-fat meat soup is allowed 1-2 times a week, provided it is well tolerated;
• dishes from lean meats, poultry, fish - boiled, baked (pre-boiled), stewed (with juice removed);
• fresh vegetables (tomatoes, cucumbers, carrots), boiled and stewed vegetables (carrots, potatoes, beets, zucchini, pumpkin, cauliflower). Non-acidic sauerkraut, fresh herbs (parsley, dill) are allowed;
• various cereals (cereals and pasta) - rice, buckwheat, oatmeal, millet; krupeniki, puddings, fruit pilaf, boiled vermicelli, pasta;
• soft-boiled egg, scrambled eggs;

5-6 months after partial or complete removal of the stomach, the attending physician, depending on the state of health, may recommend that the patient adhere to a diet of table No. 5 or 15.

• whole milk (with good tolerance) or with tea, dairy dishes, kefir, curdled milk, acidophilus, sour cream (mainly as a seasoning), freshly prepared cottage cheese. They also cook cottage cheese, various puddings, soufflés, dumplings;
• fruits and berries ripe, raw and baked (apples);
• dairy, sour cream, fruit sauces;
• Doctor's sausage, low-fat ham, jellied fish, cheese, boiled tongue, salads from raw and boiled vegetables, soaked herring;
• jam, honey, marshmallows, marshmallows, jams (in very limited quantities);
• tea, weak coffee with and without milk. Compotes from fresh fruits, berries and dried fruits (not very sweet);
• fruit, berry (not very sweet), vegetable juices. A decoction of rose hips;
• butter and vegetable oil (oil is added to ready meals);
• wheat, rye, preferably slightly dried, bread, crackers, lean cookies, products made from lean dough.

Products from pastry, pickles, smoked meats, marinades, canned snacks, radishes, turnips, hot spices are excluded from the diet.

Approximate diet menu ("non-mashed" option):

Breakfast: tomato salad or vegetable vinaigrette, boiled meat, loose buckwheat porridge, tea with milk.

Second breakfast: fresh or baked apple or raw grated carrots.

Lunch: salad, vegetarian borsch, boiled fish (cod, hake, ice) with boiled potatoes, sauerkraut, compote.

Afternoon snack: fresh fruit.

Dinner: scrambled eggs, buckwheat cereal, tea.

At night: kefir or curdled milk.

5-6 months after partial or complete removal of the stomach, the attending physician, depending on the state of health, may recommend that the patient adhere to a diet of table No. 5 or 15. If there are no complications and severe concomitant diseases, it is allowed to include low-fat foods in the diet, more fresh vegetables and fruits, meat and fish broths, of course, with good tolerance of the patient.

Based on the book by M. Gurvich "Nutrition for Health".

Light, quickly digestible, in small portions - this is exactly what nutrition should be like 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 require 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 make a schedule for eating, and revise the diet.

How is digestion 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 are unable to absorb all the useful and nutritious substances. 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 formation. As a result - a lack of vitamins in the body, exhaustion, rapid weight loss. To avoid such manifestations, both the stomach and intestines need to be “helped” by eating according to a special system.

Nutrition rules after gastric resection

After surgery, you need to eat 5-6 times a day in small portions.

After surgery to remove part of the stomach, the patient will have a long recovery period, during which strict food intake rules must be followed. Basic nutritional advice:

• 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 eliminate foods high in carbohydrates (sugar, honey, jam, muffin);
• 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, so that the adaptation of the digestive system takes place correctly. All food should be ground, it is better to use recipes that involve steaming. The patient may refuse to eat for fear of pain. Such situations should not be allowed, otherwise malnutrition will lead to exhaustion 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 the following:

• 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 omelette 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 drink from the rosehip. For dinner - meat or cottage cheese soufflé. Before going to bed, take jelly (no more than half a glass). The same composition of products on the 4th day.
• In the next 2 days, the diet expands. Breakfast already consists of soft-boiled eggs, mashed meat and tea with milk. As a snack, you can eat grated porridge (rice or buckwheat - to choose from), and you can dine with steamed meat soufflé. Snack - unsweetened curd mass. Allowed for dinner: carrot puree and steamed meatballs. At night - again jelly.
• On the 7th day after the operation, doctors recommend eating 2 boiled eggs for breakfast, as well as pureed porridge. The second breakfast consists of steamed curd whipped mass. For lunch, you can have potato-rice soup, plus a steam cutlet and mashed potatoes. Lunch - steam fish. For dinner, you can taste jelly and cottage cheese. White bread crackers are allowed.

The first week after surgery is the most difficult. The patient is just starting 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 number 1 after resection

The patient after gastric resection is prescribed diet No. 1. It is also used to compile different types of menus intended for people with stomach and duodenal ulcers, after gastritis. It is based on simple and soft foods for the body. Recipes include steaming, boiling and baking (without crisping). Then everything is carefully crushed and ground. Warm food should be eaten - neither too hot nor too cold. If you follow this diet, you need to count calories: the daily norm is 3000 Kcal.

Approved Products

From sweets and honey must be abandoned.

It is not difficult to follow a diet, because it allows the use of a mass of tasty and healthy foods. The first dishes can be cooked 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 puree and vegetable stew, which is then ground. Fruits and berries cannot be eaten raw; they will have to be boiled, baked (for example, apples). Fruit jelly, berry and juice, rosehip drink, tea (only weakly brewed) are allowed.

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, you should also take vitamins and preparations containing iron. Doctors also usually prescribe enzyme preparations to activate the digestive processes.

Comments:

Proper nutrition after stomach surgery is important to foresee in advance. On the first day you can not eat, so the patient is given all the nutrients only intravenously. This is a prerequisite, since hunger, aspiration of the contents are prescribed for medicinal purposes. On the 3rd day, you can drink weak fresh tea, rosehip decoctions, unsweetened compote is also appropriate. You can drink up to 6 times a day, the amount is small - up to 30 ml. Further, under the supervision of a doctor, protein products are introduced, first with the help of a probe, then by the usual method. This allows you to make up for the required lack of protein in the body.

If the stomach has been removed completely, then the diet expands slowly, especially if surgery was performed as a result of the discovery of neoplasms. From day 4, the diet can be expanded, it is allowed to eat mashed potatoes, soufflé, soft-boiled eggs. It is allowed to use cottage cheese, as well as fish or meat products. On day 6, you can eat steam omelettes, you can cook vegetable puree or rub vegetables.

All portions for the diet are compiled in such a way that each dose accounts for approximately 50 g.

From the 5th day, the patient can be given protein foods, portions are gradually increased. On the 7th day, each dose can already include 200 ml, on the 10th day, the portion can be close to 350 ml. Products are used only permitted, everything that causes bloating should be avoided.

During operations on the stomach, attention must be paid to which foods can be consumed. This is important for any type of surgery, a properly formulated diet will have a certain better therapeutic effect in conjunction with drugs. You can eat the following set of products:

1. Bread and flour products. Only the so-called gray bread, unsweetened buns are used, unbuffed cookies are allowed. Good for rye bread.
2. Soups are prepared vegetarian, you can cook broth with vegetables. Beetroots are included in the diet (only from fresh cabbage), borscht is not prohibited. Once every 7 days, veal or chicken soup is allowed.
3. Meat and fish - only low-fat varieties, you can cook it in a baked form or boil it. These are dietary varieties of poultry meat, veal is recommended for patients, pike, carp, cod are allowed to be used from fish.
4. Protein omelettes once a day, a boiled egg is allowed (only soft-boiled).
5. Porridge should be made only crumbly, viscous, without sugar and salt. Cereal casseroles, boiled pasta are well suited, you can cook rice, buckwheat porridge, from hercules. Semolina porridge is allowed in limited quantities.
6. Greens and vegetables are used only in boiled, raw form, sauerkraut - rarely and little. Vegetable vinaigrettes are allowed, zucchini can be stewed, light salads prepared, tomatoes are consumed only with vegetable natural oil.
7. Berries and fruits are allowed in their natural form, but there are also restrictions here. Grapes are forbidden, juice from it is possible only in small quantities. With the permission of the doctor, you can include honey, jam, and some sweets in the diet.
8. Sunflower and olive oil (natural) are allowed, do not be lazy to cook homemade ghee or you can buy it.
9. Milk is allowed with tea or whole, kefir only 1-1.5%, yogurt, sour cream can only be used with salads. Cottage cheese is better to buy fresh.
10. The diet can include only sauces on vegetable broths, with the addition of natural butter, sour cream.
11. Snacks. The diet for the stomach after surgery may include low-fat meat pates, cheese and ham are allowed (but without lard). For a change, dietary sausages, jelly without gelatin additives are added.
12. Beverages. Very weak tea (preferably with milk), unsweetened juices, vegetable or berry, fruit (except grape), rosehip decoctions, weak coffee, but with milk.

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Nutrition after gastric surgery should be taken seriously, since during the rehabilitation period and after its completion, the gastrointestinal tract system will no longer work as before. Allowed products:

1. Soups must be included in the diet, they are cooked on cereals, vegetable broths. All soups should be pureed, but millet or white cabbage should not be added to them.
2. Flour products. You can eat yesterday's bread, lean cookies, crackers, unsweetened buns. You can not eat sweet, fresh bread, butter cookies - all this should be completely excluded from the diet. You can start eating bread only a month after the operation was performed.
3. Eggs, egg dishes. It is allowed to eat no more soft-boiled eggs per day, a protein omelette is allowed, but no more.
4. Fish, meat. You can eat dishes from lean beef, veal (without tendons), turkey, chicken. In the menu you can include cod, carp, pike perch, carp, pike - all this in chopped form. You can eat rolls, cutlets, quenelles, soufflés, you must first boil them, steam them, bake them.
5. Dairy products can be added to the menu after the operation, for example, milk is allowed with tea, if tolerated, regular whole milk is also possible. Sour cream is used only as a seasoning, cottage cheese is non-acidic, mashed.
6. Greens, vegetables. Such products are allowed only as pureed and boiled cabbage, only cauliflower can be included in the diet, pumpkin or zucchini - stewed. The menu should include mashed potatoes, carrots, beets.
7. Sweets, berries, fruits only in limited quantities. Candy is excluded.

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Sample menu for 1 day

With food after operations on the stomach, one must be very careful, since not all of it is allowed to be used. A sample menu for 1 day (unmashed food) may include the following set of dishes:

First breakfast:

• boiled piece of meat;
• salad of fresh cucumbers, tomatoes and sour cream as a condiment;
• oatmeal porridge (required without sugar);
• tea (may be with milk).

Lunch:

• apple (fresh);
• 50 g hard cheese.

• vegetarian borscht (based on vegetable broth);
• stew (boiled meat, combined vegetables);
• jelly (not on sugar, but on xylitol).

• a piece of boiled fish;
• boiled beets (can be baked).

Dinner:

• meat soufflé;
• a small cheesecake (with cottage cheese, but without sugar);
• a small amount of stewed carrots.

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. Gastric surgery is a radical method for the treatment of extensive malignant neoplasms ( stomach cancer ), not amenable to conservative treatment, polyps, gastric bleeding. Despite the progress of medicine, the removal of the stomach remains one of the most difficult surgical operations, and even with its successful implementation and the absence of severe complications, rehabilitation takes a long period of time, and nutrition after gastric surgery is the most important component of this process.

Diet after gastric resection or after removal of part of the stomach

Parenteral nutrition after gastric resection begins with sequentially administered Diet No. 0A , 0B , 0V ( , 1B surgical). Their intended purpose is to provide the patient's body with a minimum amount of basic food nutrients, unload and sparing the stomach, prevent bloating, and. 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 in 15-20 minutes by 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 fats and 180-200 g of carbohydrates. The volume of free fluid 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 between 760-1020 Kcal. Food is served in liquid form. Fractional diet - up to 7-8 times a day and the amount of food at one meal is not more than 250 g. The diet includes mucous decoctions with cream, light low-fat meat broth, fruit and berry jelly / jelly, sweet rosehip broth, 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 fats 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 a liquid/puree form. Diet - up to 6 times a day, the volume of servings should not exceed 400 g. In addition to permitted products Diets No. 0A the diet is expanded by adding slimy cereal soups cooked in vegetable broth, soft-boiled eggs, liquid mashed rice and buckwheat cereals, protein steam omelets, mashed diet meat and fish, sweet berry kissels.
• Diet 0B . It is a diet of the transitional stage to the subsequent physiologically complete nutrition. Contains 80-90 g of proteins, 70 g of fats and 320 g of carbohydrates. The volume of free fluid 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 in puree form. Diet - 5-6 times a day. The diet additionally includes cream/mashed soups, mashed steamed meat and fish, cottage cheese mashed with cream, fermented milk drinks, baked apples, mashed fruit/vegetable puree and 50-75 g of white crackers.

The duration of each of the surgical diets is 2-4 days, but, if necessary, the period of stay 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 according to Pevzner (wiped version), in which the amount of food consumed at one time is limited: no more than 250 g of the first mashed dish or a glass of liquid ( 250 g), and for lunch - only two dishes. Eating fractional, 5-6 times a day.

The diet contains an increased amount of protein (100-110 g), which is used as dishes from boiled minced meat, boiled fish, fresh mashed / calcined cottage cheese, egg white omelettes. 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 well (and in its pure form too), which is manifested by bitterness in the mouth, regurgitation, diarrhea, their amount is limited to 60-70 g. The carbohydrate content is reduced to 300-320 g due to easily digestible carbohydrates.

In some cases, in particular when dumping syndrome manifested by weakness, heartbeat , chills, feeling hot, abdominal pain and bloating that appear after eating, it is necessary to completely exclude foods containing sugar, since the use of easily digestible carbohydrates is one of the reasons for its appearance.

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 in a prone position. Eating in uniform small portions 6-7 times a day. After eating, you need to lie / recline in bed for 30-40 minutes. You can also practice eating butter before eating carbohydrate food, which inhibits the removal of food from the gastric stump. With poor tolerance of whole milk, 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, spicy snacks, salted fish and vegetables, solid animal fats, uncooked raw vegetables and fruits.

If the patient feels well, 3-4 months after the operation, he is gradually transferred to the non-wiped version. Diet #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. Culinary methods of food processing are preserved: the products are boiled or steamed, and after boiling they are baked or stewed. In terms of a set of foods, the diet of this diet option is more extensive, but the rules and restrictions are the same.

It is allowed to use low-fat meat soups, borscht, cabbage soup (once a week), dried wheat bread, low-fat varieties of fish and beef, chicken dishes, lean cookies. It is allowed to use boiled and raw vegetables, garden greens, sour-milk products, dishes based on buckwheat and rice, potatoes, mild low-fat cheese, dietary sausages, fresh fruits and berries.

In the absence of complications and satisfactory function of the gastrointestinal tract, 6 months after surgery, the patient can switch to a normal diet, but taking into account the diet and the characteristics of the chemical composition of the diet. Self-correction of a set of food products in the diet is possible, taking into account individually intolerable products. With a pronounced loss of body weight (by 10-15%) after gastric resection, especially for cancer, the calorie content of the daily diet should be increased compared to the physiological norm by increasing the content of the main dietary nutrients recommended for the diet.

With the appearance of complications such as inflammation of the anastomosis or gastric stump, the occurrence of peptic ulcer assign the worn option Diet #1 , and during exacerbation - consistently 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 designed dietary nutritional mixtures in nutrition after stomach surgery - " Nutrizon », « Nutridrink », « Berlamin Modular ”, which should be administered in small portions, can be diluted with water, with a constant assessment of their tolerability.

Dietary nutrition 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 ( Creon , Mezim-forte ). Complete rehabilitation of patients is long and usually occurs by the end of the first year after surgery.

Indications

Resection of the stomach and complications of the operated stomach.

Approved Products

Diet after resection of the stomach when transferring the patient to Diet #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 second courses, low-fat types of red meat (veal, beef), chicken or turkey meat, well boiled and passed through a meat grinder, are used.

White fish dishes (cod, pollock, pike, hake) are allowed in the form of steamed or boiled fish. Cereal dishes are prepared with milk/water in the form of liquid porridge 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 boiled soft-boiled.

From fats, preference is given to butter and vegetable oils, added immediately before use in the finished dish. Kissels and jelly from sweet berries are useful. From drinks - juices from fresh berries, weak tea with cream, rosehip infusion.

Table of allowed products

	Proteins, g	Fats, g	Carbohydrates, g	Calories, kcal
buckwheat (ground)	12,6	3,3	62,1	313
oat flakes	11,9	7,2	69,3	366
white rice	6,7	0,7	78,9	344
white bread crumbs	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
kissel	0,2	0,0	16,7	68
rosehip juice	0,1	0,0	17,6	70

Wholly or partially restricted products

In the diet of the patient after surgery on the stomach, bakery and confectionery products, fresh bread, pastries, products from any kind 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 cooking fats, fried foods, pickles, mushrooms, various snacks, vegetables and raw fruits, fatty cottage cheese, cheese, sour cream, dairy products.

You can not include various sauces and seasonings, spices in the diet. It is forbidden to drink carbonated drinks, strong tea, coffee, concentrated vegetable and fruit juices, any alcohol-containing drinks.

Table of prohibited products

	Proteins, g	Fats, g	Carbohydrates, g	Calories, kcal
Vegetables and greens
vegetables	2,5	0,3	7,0	35
legume vegetables	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
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
pasta	10,4	1,1	69,7	337
Bakery products
bagels	16,0	1,0	70,0	336
wheat bread	8,1	1,0	48,8	242
Confectionery
jam	0,3	0,2	63,0	263
candy	4,3	19,8	67,5	453
confectionery cream	0,2	26,0	16,5	300
Ice cream
ice cream	3,7	6,9	22,1	189
Cakes
cake	4,4	23,4	45,2	407
Chocolate
chocolate	5,4	35,3	56,5	544
Raw materials and seasonings
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
Milk products
sour cream	2,8	20,0	3,2	206
Meat products
pork	16,0	21,6	0,0	259
Salo	2,4	89,0	0,0	797
Sausages
sausage with/dried	24,1	38,3	1,0	455
sausages	12,3	25,3	0,0	277
Bird
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
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
creamy margarine	0,5	82,0	0,0	745
animal fat	0,0	99,7	0,0	897
culinary 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
Soft 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 per 100 g of product

Nutrition menu after gastric resection (Diet)

The menu for a week after gastric resection should provide an alternation of various protein and cereal dishes in order to prevent its monotony, with strict observance of the permitted methods of culinary processing of products and, most importantly, respect for the volume of servings. At the same time, it must be remembered that meat / fish dishes are allowed to be consumed in the form of mashed potatoes or soufflés 1 time per day. If milk is intolerant, it must be replaced with other products or consumed in small portions, as well as diluted with weak tea.