As the old saying goes, "The people take food as heaven." The digestive system is crucial to everyone's daily diet, and for patients or their families who need to undergo digestive surgery, the most concerned but often the most confusing question is the question of "eating" - "what can patients eat after surgery, is there any taboo?" "Do you need to eat more meat to make up for it?" So, in patients who have undergone digestive surgery, what are the key points to pay attention to in the perioperative diet? Today, the basic surgeons of Peking Union Medical College Hospital will answer your questions one by one.
About the author: Liu Chengxi
Postdoctoral Fellow in Surgery and Clinical Medicine, Peking Union Medical College Hospital.
Audit expert: Guo Junchao
Chief Physician of Basic Surgery department of Peking Union Medical College Hospital, doctoral supervisor. He is also the vice chairman of the Cancer Metabolism and Treatment Professional Committee of the Clinical Precision Medicine Professional Committee of the Chinese Medical Doctor Association, a member of the Experimental Surgery Group of the Surgery Branch of the Chinese Medical Association, a youth mentor of the Health Youth Innovation Center, and the deputy editor-in-chief of Pancreas Magazine.
How do I know if I've eaten enough?
Surgery is a "battle" between patients and doctors against the disease, as the saying goes, "the soldiers and horses do not move, the grain and grass go first", and a good nutritional state of the body is related to the success or failure of the "battle". Adequate nutrition plays an important role in ensuring the nutritional status of patients and improving postoperative recovery.
According to the latest guidelines of the European Society for Parenteral Enteral Nutrition (ESPEN) on home nutrition therapy, if the total daily energy intake of patients for a week is less than 10 kcal per kilogram of body weight, special nutritional interventions such as indwelling jejunostomy tubes and intravenous nutrient solutions are required.
According to the above standards, a 60 kg adult needs to consume at least 600 kcal of energy per day, which is converted into about 400 grams (about 5 to 6 eggs), converted into about 3 white steamed buns, and converted into white rice porridge needs about 1 kg. Therefore, if you only drink a bowl of porridge (about 200 ml) every day after surgery, don't tell the doctor "I ate enough" during the follow-up consultation. The types of food are different, the energy contained is also different, you can choose your own food calorie calculation tools.
In addition to food, doctors often explain to patients that they need to ensure the amount of water they drink every day. Normal people need to drink 2000 ~ 2500 ml per day, if there are special circumstances, you need to make appropriate adjustments according to the doctor's instructions, generally need to ensure that the daily urine output is more than 500 ~ 1000 ml.
The amount of food eaten at each meal is also very exquisite. Doctors often instruct patients to "eat less and eat more meals", for example, to break up the original three meals into six meals, the total amount is unchanged, so as to avoid abdominal distention and indigestion caused by eating a large amount of food at a time.
Full-flow, semi-liquid, low-residue diet
After the operation, the doctor will often tell the patient that he needs to eat "whole liquid food", "semi-liquid food" or "residue-free diet", so how to judge which kind of food belongs? It is mainly judged according to the physical form of food.
Whole flow food requires food to be in a completely liquid state, which does not have any solid form, mainly including water, juice, milk, pure rice soup (no rice grains) and so on. In foreign studies, clear liquid diets (Clear Liquid Diets) will be further distinguished in total liquid foods, including only clear and transparent liquids, such as water, juice, sports drinks, etc., which are generally used as a transition before the full liquid diet.
Semi-liquid food requires that the food be mainly liquid, but can contain a small amount of solid contents, such as porridge, rice soup (with rice grains), noodle soup, egg soup, tofu flowers, etc.
There is also a special diet called the low-residue diet, which is usually used during preoperative preparation, such as gastrointestinal preparation before colonoscopy or colorectal surgery. This dietary pattern mainly restricts the intake of foods rich in dietary fiber, such as vegetables, whole grains, nuts, etc., to reduce the formation of food scraps, thereby reducing the amount of formed stools. However, it should be noted that this diet itself lacks enough fiber, and long-term use will cause serious gastrointestinal dysfunction, such as constipation, diarrhea and so on.
Low-fat diet
Some postoperative patients will be asked by the doctor to undergo a "low-fat diet", especially postoperative patients with the hepatobiliary system and pancreas. This is mainly to prevent stimulating bile secretion after eating fat, and to add too much pressure to the biliary tract system that has just finished surgery.
A low-fat diet first requires a maximum of 50 grams of total fat intake in daily foods (no more than 25% of the food supply). In terms of food selection, try to choose foods with less fat content, such as vegetables, lean meat, fish, etc. At the same time, in terms of cooking methods, we also need to pay attention to avoid a large number of cooking oils, try to choose steaming, stewing, boiling, boiling, braising and other methods, to avoid frying, frying. In the daily diet, you also need to pay attention to those "hidden" fats, such as eggs, dairy products, animal offal, nuts, etc., these invisible fats are just easy to over-ingest.
In addition, it is also important to improve the quality of the fat ingested. Recent studies have shown that omega-3 fatty acids and fish oil fat milk have a certain role in promoting postoperative recovery and should be properly ingested as high-quality fats.
Doctor Concordia warmly reminds that patients after digestive system surgery are like regaining the digestive tract of a newborn, and all dietary adjustments should follow the principle of slow, gradual, and small amounts, and should not be anxious. If you are unwell, please consult a doctor in time
The source of this article is "West Courtyard Classroom"
The West Courtyard Classroom is a health science popularization activity jointly launched by the General Branch of the Party of the West Courtyard and the Affairs Management Office of the West Dan Campus, and has been held for more than 60 sessions since June 2020. He has invited experts inside and outside the hospital and postdoctoral fellows in clinical medicine to give lectures, from "how to configure a small family medicine box" to "how to carry out clinical scientific research work in good faith", with rich content and close to life. Through online teaching, real-time interaction, graphic summary and other forms, The West Campus Classroom is committed to being a "health tip" around the public.
bibliography
[1] ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017.
Parenteral enteral nutrition terms[M]. Medical Terminology Approval Committee Parenteral Enteral Nutrition Terminology Approval Subcommittee. 2019.
[3] ESPEN guideline on home parenteral nutrition. Clin Nutr. 2020.
[4] ESPEN guideline on home enteral nutrition. Clin Nutr. 2020.
Chinese expert consensus on perioperative whole-course nutrition management in pancreatic surgery (2020 edition)[J]. Chinese Journal of Gastrointestinal Surgery. 2020,
[6] Clear Liquid Diet. StatPearls [Internet]. 2021
[7] Full Liquid Diet. StatPearls [Internet]. 2021
Source/West Campus Classroom
Pictures/network
Editor/Hong Chengwei
Editor-in-Chief/Chen Mingyan
Producer/Wu Peixin