In modern gastroenterology, a difficult situation has arisen that causes a decrease in the effectiveness of complex treatment of patients who have undergone bowel resections of various sizes, as the Internet publication for girls and women from 14 to 35 years old Pannochka reports.. net The introduction into clinical practice of improved methods of surgical treatment of patients with severe pathology of the small intestine is not ensured and is not supported by an optimal diet during the rehabilitation process.

Traditional approaches to therapeutic nutrition, based only on the principles of balance of nutrients supplied to the body, cannot be characterized as adequate, physiological..

Our own experience and data of other researchers testify to the expediency of other approaches to solving nutritional problems of rehabilitation of patients after intestinal resection, from the standpoint formulated by Academician A.. Coal theory of adequate nutrition.

It is necessary to ensure not only the elemental restoration of the content of nutrients in the body, but also the earliest possible start of stimulation of cavitary and membrane digestion, absorption processes in the intestine, the establishment of normal intestinal microbiocenosis, and the normalization of the entire digestive tract.

In the immediate postoperative period, there is practically no absorption of nutrients from the digestive tract.. However, immediately after the relief of such life-threatening conditions as dehydration, hypovolemia, hypotension and electrolyte disturbances on the 2-3rd day after the operation, it is necessary to establish parenteral nutrition of the patient.. First of all, this concerns the introduction of energy substrates.. The volume and composition of parenteral nutrition is determined individually depending on the needs of the patient..

Stabilization of the patient's condition and controlled diarrhea are indications for the transition to nutrition using the gastrointestinal tract. This usually happens 3-4 days after surgery.. At the same time, with extensive resections of the small intestine, some experts recommend starting enteral nutrition 2-4 weeks after surgery..

Unreasonably early transfer of patients to natural nutrition after operations on the intestines significantly worsens the course of the recovery period, stimulates the development of enteral insufficiency syndrome, disrupts the natural mechanisms of cavitary and membrane digestion.

In most clinical cases, standard mixtures for enteral nutrition are prescribed, however, when resections of the small intestine, it is advisable to use depolymerized nutrients (semi-elemental diets).

Combined parenteral-enteral nutrition in the complex rehabilitation of patients after surgical interventions on the intestines can reduce the time and increase the effectiveness of rehabilitation treatment, significantly reduce the incidence of complications and adverse outcomes of the postoperative process.

Assigned diets.

In health care facilities, surgical diets No. 0a, 1a, 1, 1b are traditionally prescribed sequentially..

Given the low protein and energy value of diet No. 0a, the body of patients experiences nutritional hunger during the entire time of reduced nutrition..

As a result, the prevalence of catabolic processes over anabolic and insufficient protein supply of reparative regeneration significantly inhibit tissue repair mechanisms, create conditions for the formation of a further unfavorable course of the disease..

This is more difficult to tolerate by patients if metabolic disorders have already formed in the preoperative period, therefore, dietary treatment using diet No. 0a requires simultaneous parenteral nutrition of patients using plastic and energy nutritional support..

With sufficient tolerability of the diet No. 0a, the absence of diarrhea or its stable pharmacological correction, after 2-3 days, patients should be transferred to the surgical diet No. 1a. It is prescribed for 2-4 days after diet No. 0a, however, if it is possible to carry out transfusions of protein-energy mixtures and in the presence of at least a mild enteral syndrome, the appointment of surgical diet No. 1a should be postponed for a few more days.

Proper diet therapy after surgery helps to reduce the incidence of complications and faster recovery of the patient..

Nutrition at the stage of post-hospital rehabilitation should:.

1) provide sparing of the intestines, as well as other parts of the gastrointestinal tract;

2) contribute to the normalization of metabolism and the restoration of the general forces of the body;

3) increase the body's resistance to inflammation and intoxication;

4) promote the healing of the surgical wound.

With normally proceeding processes of rehabilitation treatment, the absence of complications, it is necessary to transfer patients to a full-fledged diet with a wide food set, but taking into account the patient's condition, food tolerance, functional activity of the gastrointestinal tract.

On average, from the 14-15th day after the operation on the intestines, a smooth transition from the surgical diet No. 1a to the surgical diet No. 1 is carried out.. In this case, for a long time, the patient should adhere to the wiped version of the diet..

Diet therapy in the first 3-4 weeks from the start of the outpatient rehabilitation phase is carried out using a surgical diet No. 1 (wiped version). If this diet is well tolerated, a gradual transition to an appropriate expanded diet is required - surgical diet No. 1 (non-mashed version).

The gradual transition from one diet option to another involves a daily reduction in the number of dishes with maximum thermal and mechanical processing of food products..

The good tolerance of the " The so-called dietary transition in the post-hospital rehabilitation of patients should take at least 2-3, and in some cases even 5-6 weeks..

After operations on the intestine, as a rule, the “sensitivity” of the gastrointestinal tract of patients to some, and in some cases, to many previously well-tolerated foods, increases.. First of all, this applies to whole milk, fatty foods, including vegetable oil, strong broths, decoctions, fresh vegetables and fruits, acidic foods, etc..

With poor milk tolerance by patients after intestinal operations, which, according to our observations, occurs at least in 65% of cases, and lasts for many months and even years, one should not resort to the practice of “training” the intestines with milk food loads [Smolyansky B. , 1984].

The experience of modern dietetics shows that lactose overload in conditions of enzymatic deficiency exacerbates secretory intestinal disorders and provokes the development of irreversible phenomena in the digestive conveyor..

With the development of postoperative lactase deficiency, even if the latter is relative, in the diet of patients, whole milk should be limited as much as possible and for a long time.. This applies to a lesser extent to dairy products (cottage cheese, sour cream, sour-milk products)..

Replacement of dairy products can be successfully carried out with soy products. Soy proteins in the conditions of post-stationary rehabilitation of patients are a very important source of additional provision of the body with a highly plastic protein..

Baranovsky medbe. en.