A frequent question that patients ask after surgery is “when can I eat” and “what can I eat”. This is especially true for patients who have had surgery on a part of the body that is closely related to “eating”, and who are particularly concerned about “eating” related issues. Although laparoscopy is “minimally invasive,” it is important to introduce the issue of diet.
Eat early and resume your diet as soon as possible
Laparoscopic surgery for gastric cancer is associated with earlier postoperative gas (i.e., farting) than traditional open surgery, which means that bowel function is restored relatively quickly, with an average of 2.94 days after laparoscopy versus 3.96 days after open surgery. Thus, patients can resume drinking and eating through the mouth as soon as possible after laparoscopic surgery. A number of clinical studies have demonstrated that early postoperative drinking and eating can be very helpful for recovery of bowel function.
Usually, patients can drink small amounts of water after surgery. In order to prevent aspiration after surgery, traditional general anesthesia requires that patients not drink or eat for 6 hours after surgery, which is a relatively large procedure with long and deep anesthesia. However, some studies have confirmed that early drinking is safe and increases patient comfort in the early post-awake period, when muscle strength returns to a normal state of spontaneous movement (i.e., level V) and the gag reflex returns. The physician will usually ask the patient to start drinking as appropriate and may then gradually increase the amount of water consumed daily.
How much to eat? Gradually resume eating
Once gas is restored, patients can begin enteral nutrition preparations and a semifluid diet, such as porridge, noodles in soup, pureed meat, steamed eggs, and cakes. Because only a small portion of the stomach remains after gastric cancer surgery or the jejunum replaces the stomach after total gastrectomy, the capacity for food is significantly reduced, so eating should be as few and as many meals as possible. In the initial stage, 3 to 5 spoons per hour are continuously replenished, and gradually increased according to the tolerance level of individual patients.
After discharge, the same principle of small, frequent meals should be followed, with 5 to 6 meals per day. Patients should monitor their weight and nutritional status, and increase the number of meals and the amount of food they eat if they experience weight loss and malnutrition. The patient’s diet should also be balanced, avoiding foods that are difficult to digest, such as too much coarse fiber and fat.
To “eat well,” rationalize oral enteral nutrition preparations
Unlike parenteral nutrition, which is an infusion of fluids, oral feeding is called enteral nutrition. Early postoperative resumption of enteral nutrition has the advantages of promoting intestinal function recovery, maintaining intestinal mucosal function, preventing dysbiosis, and reducing the incidence of postoperative infection.
Patients with gastric cancer usually do not require an indwelling gastric tube after laparoscopic surgery, so physicians usually recommend supplemental nutrition through oral enteral nutrition preparations. Enteral nutrition preparations are divided into 3 major categories:
- Amino acid, short peptide formulations, which are mixtures of amino acids or short peptides, glucose, fat, minerals, and vitamins that are directly or nearly directly absorbed without digestion and are indicated for patients with gastrointestinal insufficiency.
- The whole protein type, with whole protein or protein free as the nitrogen source, has a better taste and is suitable for patients with better gastrointestinal function.
- Component-based enteral nutrition, including amino acid component, short peptide component, whole protein component, sugar component, long chain triglyceride component (LCT), medium and long chain triglyceride component (MCT), vitamin component, etc.
The choice of enteral nutrition formulations is wide, and physicians will choose a combination of formulations based on the patient’s condition, and there are now formulations for specific populations such as oncology patients.
In conclusion, patients with gastric cancer can resume their diet as soon as possible after laparoscopic surgery, with a gradual increase in diet and attention to enteral nutrition. The above is a suggested guideline, and the specific diet plan must be decided by clinicians according to the specific condition. (Contributed by Chen Hanyu, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)