What happens after removal of part of the stomach or the entire organ * Diana Clinic in St. Petersburg

Siegbert Rossol, gastroenterologist, specialist in internal medicine

Since 2006, he has held the post of chief physician at the Nordwest Medical Clinic.

Diet to restore nutrition after resection

After surgery, it is recommended to follow the following procedure for restoring food intake:

1-2 days - drink sips, yogurt;
2-3 days - white bread, marmalade, soft cheese, mashed potatoes;
Day 4 - if well tolerated, white bread, buns, soft fats, potatoes, easily digestible vegetables, lean low-fiber meat or fish, eggs, fermented milk drinks;
During the first 10-12 weeks - a gentle menu with meals 6-10 times a day in small portions;
After 3-6 months, you can switch to 3-5 meals a day.

As a rule, the operated stomach adapts to new conditions within 2-6 months. Most patients can eat all types of food after a year, just like before surgery!

When to see a doctor?

If you have diarrhea, it is important to seek medical help immediately if you have any of the following symptoms:

signs of dehydration;
severe pain in the abdomen or rectum;
stools that are black or have blood in them;
temperature;
frequent vomiting;
a weakened immune system or other underlying health condition.

The duration of your symptoms also matters. Contact your doctor if diarrhea continues for more than two days. Be sure to contact your child's pediatrician if your child has diarrhea for more than 24 hours.

Energy requirement

Energy requirement is approximately 1/3 higher than in healthy people, about 30-40 kcal/kg/day:

Weight 50 kg = 1500-2000 kcal;
Weight 60 kg = 1800-2400 kcal;
Weight 70 kg = 2100-2800 kcal;
Weight 80 kg = 2400-3200 kcal;
Weight 90 kg = 2700-3600 kcal.

A few simple rules:

Remember that you have no feeling of hunger and satiety occurs earlier;
Chew your food well, eat slowly, not too hot and not too cold;
Do not drink while eating;
Monitor your weight daily;
Food should be easily digestible and complete;
High-quality foods rich in vitamins and minerals are important;
Nutrient ratio: 55% of the energy value should be carbohydrates, 30% fat and 15% protein.

Well tolerated:

Fats Boiled meat, grilled meat, fish, fresh butter, margarines, sunflower oil, yogurt, low-fat cheese, 1 tablespoon of sour cream before the main meal, soft-boiled eggs.
Salads Carrot, green, cucumbers, tomatoes with a small amount of marinade, sour cream or sunflower oil.
Vegetables Broccoli, cauliflower, kohlrabi, wax beans, spinach, carrots.
Some varieties of sausages

Avoid:

Concentrated sweet and flour dishes;
Meat broths;
Sweet drinks;
Milk and dairy products;
Fried;
Vegetables and fruits rich in fiber (for example, oranges);
Smoked;
Peppered;
Alcohol.

What's normal and what are the risks?

An acute case of diarrhea usually resolves on its own after a few days of home care. Chronic diarrhea may last several weeks.

But what is a normal amount of diarrhea? Although diarrhea is defined as three or more watery bowel movements per day, it is important to see a doctor if you experience six or more per day.

Risk

There are some potentially serious health risks associated with diarrhea. These conditions can quickly become serious or even life-threatening.

Dehydration

Due to the loss of fluid and electrolytes, diarrhea can quickly lead to dehydration. Symptoms may differ between adults and children.

Some symptoms adults should watch out for include:

increased thirst;
dry mouth;
very little or no urine;
dark colored urine;
weakness or fatigue;
feeling dizzy.

Dehydration in children may also have the following symptoms:

cries, but without tears;
without a wet diaper for 3 hours or more;
drowsiness;
increased irritability.

Poor absorption of nutrients

If you have diarrhea, you will not be able to effectively absorb nutrients from the food you eat. This can lead to nutritional deficiencies. Some signs that may indicate that your digestive tract is having a hard time absorbing nutrients include:

permanent gases;
bloating;
stool that smells bad or is greasy;
change in appetite;
weight loss

Possible problems after gastrectomy

Gastrectomy

Gastrectomy is an operation to completely remove the stomach.
As a rule, this operation is indicated for the development of malignant tumors. Read more about the procedure →

Nutrition after gastric resection for oncology requires special attention, since, in addition to sudden weight loss, patients may encounter a number of side effects of the operation. Below are recommendations that will help improve the process of food intake and processing by the body.

Weight loss and malnutrition Premature satiety and poor nutrition often lead to weight loss, so it is very important to constantly monitor your weight.
Heartburn The condition after surgery can lead to the reflux of the contents of the small intestine into the esophagus. To prevent such manifestations, we recommend the following measures: Frequent meals in small portions;
Chew your food thoroughly (up to 20 chews before swallowing);
Try eating ground foods;
Never lie down after eating, remain upright or moving as long as possible;
Drink not during meals, but between meals.

Fat stool If oily stool appears, it is recommended to take the following measures:

Don't eat too much fatty food!

Monitor your intake of fat-soluble vitamins (present in liver, fish oil, dairy products, chicken yolk, margarine, vegetable oils, cereals, carrots, green vegetables, fruits) and calcium (in dairy products);

For pronounced fatty stools, it is recommended to additionally take fat-soluble vitamins (for example, Adek Falk) and calcium (for example, Calcium Sandoz forte);

Take pancreatic medications (for example, Pankreon) as prescribed by your doctor.

Flatulence Increased gas formation is a common occurrence after gastric resection. The reason is that the digestion process is shortened and the food is not sufficiently processed by enzymes. How to help yourself:

Eat more often, eat small, easily digestible dishes: bread and butter, natural yogurt, vegetable soup, boiled potatoes;

Avoid vegetables that cause bloating: legumes, cabbage, onions, garlic or vegetables that you personally do not tolerate;

Be careful with raw vegetables and fruits;

Consume day-old bread;

Give preference to mild varieties of cheese and sausages;

Try yoghurts, lingonberries and blueberries, cumin, fennel and anise seasonings;

Drink tea with fennel and anise;

Avoid carbonated drinks and drinks containing caffeine;

Take pancreatic medications if necessary.

Dumping syndrome A combination of various complaints from the gastrointestinal tract with circulatory disorders, sugar swings, and skin manifestations. It occurs after eating and is accompanied by attacks of general weakness, abdominal pain, often diarrhea, vomiting, palpitations, and perspiration. To avoid such symptoms you should:

Avoid concentrated broths, rhubarb, spinach, tea, chocolate, alcohol;

Avoid quickly digestible carbohydrates, especially sugar;

Give preference to whole grain products;

Eat food slowly, every two hours, gradually increasing portions;

Avoid large portions of milk and dairy products to avoid lactose intolerance;

Do not drink during meals, but between meals (45-60 minutes after eating solid food);

Eat very hot or cold food.

Diarrhea Appear after gastric resection for various reasons. This could be the consequences of dumping syndrome or a reaction to intolerance to dairy products. In addition, diarrhea can be caused by intestinal dysbiosis, due to the lack of stomach acid that kills bacteria. In such cases, it is recommended:

Eat less milk sugar - this means less fresh milk, powdered milk and products such as condensed milk, processed cheese, etc.;

Give preference to fermented milk products;

Avoid foods that may contain bacteria, such as raw meat, undercooked meat, raw eggs, and raw milk products;

If you have diarrhea, drink at least 2 liters of fluid per day.

It can occur immediately after surgery or later, as a result of a lack of vitamins or iron, which is confirmed in their reviews after longitudinal gastrectomy by patients at the Nordwest clinic who were diagnosed in Germany and faced this problem. Support your blood with a varied diet! Recommended:

Eat foods rich in vitamins and iron (iron contains bread, meat, vegetables such as spinach, peas, beans);

If you are deficient in folic acid, choose tomatoes, cabbage, spinach, cucumbers, whole grains, potatoes, meat, dairy products and eggs;

Often - additional intake of folic acid supplements (prescribed by a doctor);

Long-term supplemental vitamin B12 and vitamin B12 injections every 3 months (prescribed by a doctor);

If necessary, taking iron supplements with mandatory monitoring of iron in the blood serum;

Regularly taking multivitamins.

Osteoporosis May be a consequence of gastric resection. As a preventive measure it is recommended:

Eat foods high in calcium, such as milk, fermented milk products (mostly hard cheeses), nuts, vegetables - cabbage, broccoli;

Replenish your supply of vitamin D by eating fatty fish, liver, butter, margarines and yolk;

Reduce consumption of foods containing oxalic acid, which interferes with calcium absorption, such as rhubarb, spinach, black tea and cocoa;

Move more in the fresh air, as the sun promotes the production of vitamin D in the body.

Every aspect of nutritional recommendations is discussed with your doctor both in preparation for surgery and after surgery. If you have any questions regarding your diet after complete or partial removal of your stomach, you can contact your doctor at the Nordwest Clinic at any time via video consultation.

Diarrhea caused by local anesthesia

Diarrhea after local anesthesia is quite rare; before surgery, the anesthesiologist carefully checks the body’s reaction to the active components of the painkiller. To avoid side effects, the optimal dosage is calculated, which does not cause harm to the body. In case of an individual negative reaction to the components, the anesthesiologist selects a drug with a different composition.

Even careful selection of pain medication does not guarantee the absence of side effects. Along with diarrhea, the patient may complain of sleep disturbances, headaches, and prolonged dizziness. Malfunction of the digestive organs is another problem that may appear immediately after surgery under local anesthesia.

Doctors warn that there is no particular reason to panic. If the condition stabilizes and the side effects do not increase, the unpleasant discomfort will go away on its own, without medical intervention.

Treatment

If you are seeking medical care for a serious bout of diarrhea, your doctor will first take your medical history and perform a physical examination.

The doctor will ask you about your symptoms and how long you have had them. They typically also ask about any recent surgeries and underlying health conditions.

In addition to a physical exam, your doctor may order certain tests to try to determine the cause of your diarrhea. This may include a stool sample, blood tests, a CT scan, or possibly an endoscopy.

Below are some ways to treat your condition:

Rehydration. Diarrhea can cause loss of fluids and electrolytes, so part of the treatment plan will likely focus on replacing them. If you cannot keep down fluids, you may receive them intravenously.
Antibiotics. If bacteria is causing an infection that is causing you diarrhea, you may be able to get antibiotics to treat the infection.
Corrective medications. Some medications may cause diarrhea. If you take one of these, your doctor may adjust your dosage or switch you to another medicine.
Treatment of the underlying condition. If your symptoms are the cause, special medications or possibly surgery may be recommended.

Treatment of chronic diarrhea

If you have chronic diarrhea after surgery, your doctor may start by prescribing medications and recommending dietary changes to control your symptoms until your body adjusts.

Once your body reaches a new balance, you can stop taking the medications and get rid of the diarrhea.

In other cases, you may need ongoing or even lifelong use of medications to control or minimize episodes of diarrhea.

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