Modern clinical medicine is armed with powerful pharmacological means of pathogenetic therapy that can block the progression of many pathological processes that form inflammatory and degenerative lesions of the digestive tract..

At the same time, a fairly large list of indications for surgical interventions on the organs of the gastrointestinal tract remains..

The surgical technique of surgical treatment of diseases of the digestive system has reached a high level, and the individualization of the approach to choosing the method of operation has been worked out..

However, the operations performed after a longer or shorter period of time in a number of patients lead to various forms of postoperative disorders that require correction of treatment and individualization of the diet..

One of the main components of the postoperative rehabilitation of patients who underwent surgery on the digestive organs is therapeutic nutrition, which largely satisfies the plastic and energy needs of the body, helps to reduce the incidence of complications and faster recovery..

The most important task of diet therapy both in the conditions of inpatient and outpatient rehabilitation stages (especially the first 2-3 weeks of rehabilitation treatment) is considered to be overcoming the protein, vitamin, mineral and energy deficiency that develops in many patients due to malnutrition in the first days and even.

Nutrition of patients after operations on the esophagus.

Patients who have undergone surgical treatment of diseases of the esophagus and gastroduodenal zone are transferred to outpatient treatment, as a rule, no later than 1.5-2 months after surgery.. This is usually preceded by restorative treatment in a surgical hospital where the operation was performed, and then in the gastroenterological department, where the patient goes to aftercare, and in some cases in the rehabilitation department of a sanatorium type.

Diet therapy is an important part of the whole complex of postoperative rehabilitation of patients who underwent surgery on the esophagus. For 4-6 months of the outpatient stage of rehabilitation, a diet is prescribed, the characteristics of which are given in Table. 40. 1, 40.

Table 40. Characteristics of the diet for patients undergoing esophageal surgery at the post-inpatient stage General characteristics Physiologically complete diet with a high protein content, normal fat content, with limitation of mechanical and chemical irritants of the mucous membrane of the esophagus and stomach and the receptor apparatus of the gastrointestinal tract, with a maximum restriction of nitrogenous extractive; cold dishes over 15 °C Chemical composition:.

proteins 140 g fats 110-115 g carbohydrates 380 g energy content 3000 kcal free liquid 1.5 l; cold dishes over 15 °C Chemical composition:.

proteins 140 g fats 110-115 g carbohydrates 380 g energy content 3000 kcal free liquid 1.5 l Recommended:.

Milk and dairy products - milk with tea and other products or as part of various dishes, if tolerated - whole milk; kefir turns on 2.5-3 months after the operation; sour cream only as a condiment; non-acidic freshly cooked cottage cheese, mashed Vegetables and herbs - boiled vegetables, mashed; only cauliflower, boiled with butter, stewed zucchini and pumpkin, carrot, beetroot, mashed potatoes Fruits, berries, sweets - natural fruits and berries, fresh and dry in the form of unsweetened pureed compotes, jelly, jelly, mousses; baked apples, sugar-free non-acidic varieties; fruits and berries with coarse fiber are not allowed (pear, quince, persimmon); you can give compotes, kissels on xylitol, while sugar, honey, jam are limited.; pasta only finely chopped, boiled Fats - butter, ghee, sunflower, refined; do not fry, but add to dishes in their natural form Snacks - cheese (Dutch, Soviet, Russian, athlete, Estonian) mild grated, minced caviar, granular in a small amount, jelly from boiled legs and boiled meat on gelatin (without extractives) Sauces; flour for sauces is not browned with butter Drinks and juices - juices in the form of unsweetened fruit, berry and vegetable; they must be diluted, only freshly prepared; decoctions of rose hips; weak tea, tea with milk, weak surrogate coffee with water and milk; cold and carbonated drinks; chocolate, cocoa, ice cream; alcohol in all forms; white cabbage, legumes, spinach, sorrel, mushrooms, radish, swede, onion, garlic, spices; foods rich in organic acids: sour varieties of berries and fruits - cranberries, gooseberries, red and black currants, red cherries, lemons, sour varieties of apples. Sugar is given to the patient in a limited amount, it is recommended to use it “bite” Table 40. Approximate one-day menu of a patient who underwent surgery on the esophagus 1st breakfast: steamed protein omelette, mashed buckwheat porridge without sugar, tea with milk 2nd breakfast: meat chops, baked apple without sugar Lunch: mashed pearl barley soup with carrots, steamed meat cutlets. When the patient is in medical and preventive institutions (HCF), a variant of the diet with mechanical and chemical sparing is recommended..

Subsequently, not earlier than 1 year after the operation, subject to the normalization of all body functions, primarily the gastrointestinal tract, it is possible to expand the patient's diet to the usual diet (general diet No. 15), for health facilities the main version of the standard diet.

In cases where patients undergo chemo- or X-ray radiotherapy, a full-fledged varied food is justified for enhanced nutrition of high calorie content, with a large amount of complete proteins, fats, carbohydrates, vitamins. These patients are shown a high-protein diet (previously numbered diet No. 11).

Therapeutic nutrition of patients after operations on the stomach and duodenum.

Before the expiration of 2-4 months after surgery in an outpatient rehabilitation treatment, a wiped version of the P diet is prescribed, which helps to reduce inflammation in the gastrointestinal tract and improve postoperative healing processes. This diet is the basis for preventing the development of complications and the unfavorable course of the disease..

After 2-4 months (in some patients, after 4-5 months), it is recommended to switch to the non-mashed version of the P diet, which contributes to the further adaptation of the functioning of the gastrointestinal tract and the whole organism after a surgical injury.. It has a beneficial effect on the activity of the liver, biliary tract, pancreas and intestines..

The transition from the pureed to the non-purified version of the P diet should be done gradually.. In the early days, unmashed vegetables are recommended in small quantities, first they give unmashed vegetables in the first course, and later black bread, sauerkraut, salads are added.. A change in diet can only be carried out with good dynamics of rehabilitation treatment..

It is necessary to follow a diet that provides chemical sparing of the stomach and intestines (an uncooked version of the P diet) for a long time (up to 11.5 years), since the restoration of the functional state of the digestive organs occurs gradually, approximately during this period.

1-1.5 years after the operation, in the absence of complications from the digestive organs, the patient can eat food prepared according to the requirements of the main variant of the standard diet (diet No..

Subsequently, even if a patient who has undergone gastric resection or other types of surgical treatment of diseases of the gastroduodenal zone has no signs of complications of the operation, it is necessary to adhere to preventive measures in nutrition for 4-6 years..

At the same time, you should observe fractional meals (4-5 times a day), limit foods and dishes that most often cause dumping syndrome (sweet drinks, sweet milk porridges, very hot and very cold dishes), eat slowly, chewing it thoroughly.

Baranovsky.

medbe. en.