Medical nutrition of patients undergoing pancreatic surgery, regardless of the nature of the pathology of the organ, should consist of two stages: artificial nutrition (parenteral, tube, mixed) and natural nutrition (diet therapy itself).

Our practical experience suggests that the outcome of surgery is positively affected by the duration of artificial nutrition of the patient, adequate component composition and energy value of nutritional support, as reported by the online publication for girls and women from 14 to 35 years old Pannochka. net Thus, the duration of total parenteral nutrition of patients who underwent severe surgical interventions on the pancreas, including extensive resections, should be at least 10-12 days, provided that the diet of nutritional support is fully protein-energy. This allows minimizing postoperative complications associated with metabolic, reparative-regenerative and immune disorders..

With less severe surgical interventions, the transition from parenteral to nutrition using the gastrointestinal tract can take place no earlier than 5-7 days. This ensures not only the normal course of activated metabolic processes, but also the creation of a long functional rest of the secretory structures of the pancreas..

The second important organizational position in postoperative rehabilitation associated with therapeutic nutrition is the use of partial parenteral nutrition during the transition to enteral or natural nutrition..

The combination of a gradually increasing volume of natural nutrition with a gradually decreasing parenteral nutrition is the main requirement for therapeutic nutrition in conditions of postoperative adaptation of the gastrointestinal tract.

This allows you to maintain the protein-energy supply of the body at the proper physiological level during this period of rehabilitation and at the same time carry out a smoothly increasing food load due to a mechanically, chemically and thermally sparing hypocaloric diet..

The transition from total parenteral nutrition to natural nutrition within the recommended time frame is carried out by the postoperative administration of diets No. 0a, No. 1a surgical and No. 1b surgical, and in the future, a variant of the diet with mechanical and chemical sparing (diet No. 5p, wiped version).

When using surgical diets, diet No. 0a for patients after pancreatic surgery should be prescribed for a period of 5-7 days, and not 2-3 days, as in operations on other organs. This is due to the fact that the use of diet No. 0a should be carried out as a component of a combined (parenteral-natural) diet..

To replace diet No. 0a, a surgical diet No. 1a is prescribed for a period of 5-7 days, also filling the protein-energy deficit with parenteral nutrition. Further, the surgical diet No. 1b is advisable for a period of at least 3-4 weeks..

Great own clinical experience suggests that from the first days after surgery on the pancreas, patients should be provided with adequate quantitative and qualitative nutrients, the need for which after surgery increases significantly in relation to the physiological norm..

Failure to comply with this principle is fraught with a high risk of postoperative complications, inadequate course of reparative regeneration processes, and the formation of the so-called metabolic steal syndrome..

The second important conclusion is the need for the slowest possible food load of patients after pancreatic surgery.. Individualization of the adaptation of the digestive organs to natural nutrition in the framework of postoperative rehabilitation is carried out in stationary conditions against the background of pharmacological suppression of pancreatic secretion.

Moreover, surgical stress and surgical disruption of interorgan relationships that provide digestion significantly change the physiological course of many neurohumoral regulatory processes..

Under these conditions, the solution of issues of expanding the food ration set, switching from one diet to another, the duration of compliance with the requirements of prescribed diets and other important conditions for the individualization of therapeutic nutrition in the postoperative period requires a rigorous assessment of the indicators of the state of the body and the characteristics of the course of recovery processes..

The beginning of the outpatient rehabilitation program for patients who have undergone pancreatic surgery, as a rule, in uncomplicated cases of the course of the process, takes place against the background of dietary treatment using a diet according to the principles of a numbered diet No. 5p.

It is used for 1.5-2 months in a wiped form, and then for 6-12 months in an unwashed version, depending on the nature of the course of the recovery processes.. With good health, this diet is expanded in compliance with the gradual inclusion of new products and dishes and an increase in their volumes.. In the absence of diarrhea, the diet includes raw finely chopped vegetables (carrots, cabbage), taken at the beginning of meals 3-4 times a day, 100-150 g each.

In the postoperative period, with the development of secretory and endocrine insufficiency of the pancreas, symptoms of pancreatogenic enteropathy (diarrhea, steatorrhea, malabsorption) occur with the development of protein-energy deficiency.

The nutrition of this category of patients is based on a variant of the diet with mechanical and chemical sparing with an increase in protein in it up to 120-130 g and a decrease in fat up to 60-70 g. As a source of protein, lean meat (veal, rabbit meat, chicken), low-fat dairy products, fish, egg white are used..

Avoid foods rich in dietary fiber. Foods rich in potassium salts (carrot and other juices before meals, mashed dried fruit compotes) and calcium (calcined and unleavened cottage cheese) are introduced into the diet. The diet is supplemented with multivitamin preparations or vitamin-mineral complexes. It is desirable to include in the diet of modular protein enteral mixtures, homogenized and puree canned foods for baby and diet food..

In case of impaired glucose tolerance or diabetes, easily digestible carbohydrates are excluded from food or significantly limited, and carbohydrate sources are evenly distributed over meals, timed to coincide with the time of prescription of antidiabetic drugs.

In most cases, the correction of carbohydrate metabolism disorders can be achieved by individualizing the therapeutic diet.. Patients are prescribed a diet with the exception of simple carbohydrates and a significant restriction to 200-250 g of complex carbohydrates..

In patients after operations on the pancreas, the passage of contents through the intestines is often disturbed and symptoms of dysbacteriosis, constipation occur.. In this case, increase the amount of vegetables and fruits, increase the content of fats that inhibit the growth of enterobacteria, reduce the quota of simple carbohydrates to reduce fermentation and flatulence..

Therapeutic nutrition of patients with progressive exocrine insufficiency in the postoperative period requires special individualization..

Depending on the nutritional form of pancreatic insufficiency, manifested by intolerance to proteins, fats and carbohydrates, it is necessary to clarify the quantitative and qualitative side of these disorders: which products, in what quantity and in what combination of them the patient does not tolerate.

With this in mind, in an individual diet, it is necessary to select products that are well tolerated by the patient, determine their appropriate daily amount, taking into account the norms of the physiological provision of the patient's body for proteins, fats and carbohydrates, as well as his energy needs..

Baranovsky.

medbe. en.