The Impact of Diet on Post-Gastrointestinal Surgery Recovery

Summary

Gastro-Intestinal surgery or GI Surgery is an umbrella term for a range of surgeries done on gall-bladder, oesophagus, liver, pancreas, small-intestine, large-intestine and rectum. The surgery may be done to correct some anomaly, remove damaged tissue, or remove cancerous tissue to halt the spread of cancer. Patients who undergo such surgeries are put on a strict diet plan for two months post-surgery. Not following this diet, also called Gastric Bypass diet, can increase the risk of complications. In this article, we will learn more.

Introduction

There is a wide range of surgeries done on the GI tract. This includes:

• Colon and Rectal Surgery: To treat disorders of the rectum, colon, and anus
• Nephrectomy: Removes a kidney affected by a disease or cancer
• Adrenalectomy: Removes growths on one or both adrenal glands
• Foregut Surgery: Treats conditions of the oesophagus, stomach and small intestine
• Appendectomy: Removes an infected or diseased appendix
• Splenectomy: To remove the spleen
• Hiatal Hernia Repair: To correct hiatal hernia, which is an opening in the diaphragm
• Bariatric Surgery: Makes the stomach smaller to aid in weight loss
• Pancreatic Surgery: To treat various pancreatic conditions
• Cholecystectomy: To remove gall-bladder affected by gall-stones.
• Nissen fundoplication: This helps strengthen the muscles between oesophagus and stomach, to treat severe cases of acid reflux or gastroesophageal reflux disease (GERD)
• Retroperitoneum Surgery: To treat testicular cancer.
• Whipple Procedure (Pancreaticoduodenectomy): To treat cancer or other growths in the pancreas or duodenum
• Gastric Bypass Surgery: This bypasses or connects the intestines, in order to treat severe reflux or obesity. Also called Roux-en-Y procedure

The procedure may be open incisional, laparoscopic or robotic.

In all these surgeries, one common factor is that, in order to hasten recovery, the person has to follow a special diet. This is called the Gastric Bypass (GB) diet (although Gastric Bypass is just one of the different GI surgical procedures). Post-surgery, the GI tract must be allowed time to heal or recover quickly. One way of ensuring this, is by not loading or stressing the GI tract with regular food. Simpler and easier-to-digest food is provided to accelerate recovery. The diet is spread across two months and consists of 4 stages. The duration of each stage can vary from patient to patient depending on the specific surgery done, and how he/she is reacting to the diet.

Stage 1 – Clear Liquids

Immediately after the surgery and for nearly a week, the person must consume liquids that are clear (transparent or translucent). This includes:

• Plain water
• Diluted or clear juices of sweet-lime (mosambi), apple or grapes
• Tea and coffee without milk or cream, such as lemon tea or ginger tea without milk
• Diluted sherbet
• Popsicles
• Diluted or clear soups of vegetables
• Carbonated water or club soda
• Honey

Stage 2 – Full liquids

In this stage, liquids that are not transparent or translucent is given. Solid matter that is neatly ground and strained, is present in the liquid. This includes:

• Whole milk
• Coffee and Tea with milk or dairy creamer
• Plain or flavoured buttermilk
• Milkshakes that are not very thick
• Vegetable soups that are strained in order to remove excess pulp
• Porridge (kanji or payasam) that is strained in order to remove excess pulp
• Nutritional drinks like Boost or Bournvita

Please note, savoury drinks should be just salted. Spices (chillies or pepper), sour matter (like lemon, tamarind or vinegar) and masala powders, should be completely avoided. These can irritate the stomach and induce nausea, vomiting or diarrhoea.

Stage 3 – Soft or Pureed Foods

In this stage, the person is given soft foods that have been pureed. That is, solid matter is present in a little more quantity, compared to the previous stage. This includes:

• Lean meat like poultry or fish that is nicely ground and added to hot water
• Cottage cheese (paneer) that has been softened and mixed with water
• Scrambled eggs that are soft and mushy
• Cooked dals (lentils and pulses) that are mashed well and mixed with water
• Soft fruits such as banana, seetaphal, orange and mosambi (avoid crunchy fruits like apple)
• Cooked and salted vegetables
• Vegetable soups that are thicker
• Milkshakes that are thicker
• Porridge (kanji or payasam) that is thicker

In this stage, the doctor or dietician involved in the case, may allow a little sourness (lemon/tamarind/vinegar) and spices, in a very small quantity.

Stage 4- Solid Foods

In this stage, which usually is 2 months after surgery, the person can return to solid foods that do not contain too much fibre, that do not contain too little fibre (foods made of maida), foods that do not have a lot of fat or oil in them, and food that is not spicy.

Too much fibre can delay digestion and stress the GI tract. On the other hand, too little fibre can cause constipation. Oily and spicy foods can induce acid reflux, coughing and sneezing (due to allergic rhinitis). Such sneezing and coughing spells can put a strain on the stitches where incisions have been done.

So, foods that must be avoided in this stage are:

• White bread
• Carbonated drinks as they can induce gas when mixed with solid food
• Raw vegetables, as in salads
• Cooked vegetables that have a lot of fibre (cruciferous vegetables like broccoli, cauliflower or cabbage, corn, some leafy greens like celery and amaranth)
• Tough meats or meats that have gristle on them
• Red meat
• Fried foods or snacks
• Highly seasoned pickles and spicy curries
• Nuts and seeds
• Popcorn

Consume simple and homely food that are easy to cook and digest.

Risks from not following the GB diet

Following the GB diet requires some discipline. Patients who try to cheat, or look for shortcuts once in a while, can end up with complications such as:

• Dumping syndrome: This occurs when food enters the small intestine quickly. This happens when the person is eating too much or too quickly, the person is not chewing the solid food thoroughly (in stage 4), or the food is high in fat and/or sugar. The syndrome can induce nausea, vomiting after meals, diarrhoea, sweating and dizziness.
• Dehydration: In stage 4, the doctor will advise against consuming fluids along with meals. Water or fluids should be consumed after meals and throughout the day. Those who fail to follow this instruction can get dehydrated.
• Constipation: In stage 4, consuming solid foods that are low in fibre (such as maida) or very high in fibre (salads and tough vegetables), not drinking enough water, when combined with a sedentary lifestyle or lack of physical activity can cause constipation.
• Blocked opening of your stomach pouch: In spite of following the diet strictly, some people can experience this, where in food can get blocked at the opening of the stomach pouch. This will induce vomiting, nausea and abdominal pain. In such a case, the case doctor must be called immediately.
• Weight gain or inability to lose weight: One of the consequences of the GB diet is a healthy weight-loss. However, if that is not happening and the person is gaining weight, then the case doctor must be called immediately. The diet may have to be adjusted, or there could be a new or hidden problem that has come up now.

It is important to be in touch with the case doctor and the dietician regularly, till complete recovery has happened and the person has resumed his/her normal routine.

After Cholecystectomy, what foods to take?

Some people develop stones in the gall-bladder (gall stones), in which case, the entire gall-bladder is removed. The procedure to do so is called Cholecystectomy. People who have undergone this procedure, need to follow the GB diet described above, for the specified duration. The diet is in four stages, in which, the person is allowed to consume clear liquids in stage 1, full liquids in stage 2, soft/pureed foods in stage 3 and solid foods in stage 4.

 

 

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