Major Surgery

Nutrition can help in recovery from surgery

Nutritional Support during Surgery: Improving Patient Outcomes

Surgery is essentially an invasive technique. It opens up a specific part of the body by cutting through skin and other tissue, exposing it for examination and intervention. Following the operation, patients must recover not only from their original disease, but also from the surgery itself. This is where nutritional support becomes important.

 

Successful wound healing involves various processes, all of which lead to higher demand for nutrients, and as such, nutritional deficiencies can hamper wound healing.1

 

Oral protein supplementation may improve survival and prevent complications in patients undergoing surgery.2 Adequate protein intake also regain muscle strength, especially during rehabilitation in orthopaedic cases.3

 

Amino acids arginine and glutamine are not only vital for tissue repair; they have also been shown to play a role in supporting the immune system and thereby help reduce the risk of post-surgical infections.1,4 Similarly, omega-3 fatty acids are also thought to be “immune-modulating” and have been shown to reduce postoperative complications, infections and length of hospital stay.5

 

The use of oral nutrition supplements is not restricted to the period after surgery; studies indicate that patients may also benefit from receiving oral nutritional supplementation even prior to the surgery.6,7 

 

When it comes to oral protein supplements for patients, whey protein is a common constituent used. Hydrolysed whey protein provides partially broken down protein, suitable for individuals that require a quickly-absorbed protein source.

 

Many patients who require surgery are malnourished or unable to eat before or after the surgery. In these individuals, providing nutrition support, either by oral nutritional supplements or tube feeding, is necessary.7 A dietary plan can be created and started before the patient undergoes surgery. If required, oral nutrition formula can be given via a feeding tube. Ensuring that nutrition adequacy is met in these patients can help improve patient outcomes.8       

 

Having a stoma should not change your enjoyment of food

 

Eating is one of life’s great pleasures. Individuals who have had ostomy surgery will want to eat a regular balanced diet that includes the necessary vitamins, minerals and calories needed for good health. Usually after surgery you start out with a low-fi ber/low-residue diet. The reason is that surgery causes the bowel to swell. This swelling reduces in about six to eight weeks, then a regular diet can be resumed, adding specific foods one at a time to judge their effects. 9 Your stoma care nurse will assist you in determining your personal needs as food tolerances can vary from person to person.

 

 

The following general guidelines will help make caring for your stoma easier:

 

  • Start with a low fibre diet9; as recommended by your stoma care nurse
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  • Eat meals regularly9,10; You should eat three or more times a day. An ostomy works best this way and produces less gas. Remember, when you eat is as important as what you eat, so try adjusting the time between meals, or see if your body responds better to a different meal time. Traditional meal patterns cause increased output later in the day. Sleep better by limiting foods and fluids in the evening.
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  • A nutritious and balanced diet9; Individuals who have had ostomy surgery will want to eat a regular balanced diet that includes the necessary vitamins, minerals and calories needed for good health.
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  • Chew your food well10; Chewing well will help to avoid a blockage at your stoma site. If you have an ileostomy, be especially careful when chewing foods that may be hard to digest or foods that have high fiber content.
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  • Try new foods one at a time9,10; ; Learn which foods may give you annoying side effects such as excess gas, constipation, a looser stool, or odor. If a new food seems to give you problems, eliminate it for a few weeks, but try it again later. You may find something else was causing your problem. Be patient and keep experimenting to find the combinations that give you the results you want.
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  • Avoid gaining excess weight10; Once you are on the road to recovery, you should avoid gaining excess weight. Extra weight is not good for your ostomy, and it can cause health problems in general.
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  • Drink a lot of fluid daily10; You may lose more body fluids than usual. So it is important to drink a lot of fluid. Ileostomy patients and colostomy patients who have lost a large part or all of their large intestine will especially notice more fluid loss. This is because most of the body’s fluid is normally reabsorbed in the large intestine.
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  • Special need for protein and immunonutrients; Since there are so many cellular activities happening during the healing process, it is important to make sure you are getting good nutrition to support those cells. Healing is hard work for the body, and increases its demand for calories, protein, and special nutrients like amino acids, immunonutrients, certain vitamins and minerals. Increasing your intake of these important nutrients can be as simple as adding an oral nutritional supplement to your diet. Immune-modulating formula enhances wound healing, strengthens the body and boosts the immunity, which may improve outcomes, survival and prevent complications. Make an appointment with a dietitian if you have a poor appetite or your recovery is not progressing well.
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  • Above all, remember that no two people will react the same to foods9,10; You will learn through experience which foods, if any, you should avoid. It may be helpful to keep a list of foods that you try and write down how they make you feel. Lactose intolerance is common. If you notice gas, abdominal bloating, increased liquid output or diarrhea ten minutes to several hours after the ingestion of a dairy product, eliminate it for several days. You may then add milk, one ounce at a time, to determine your tolerance point. You may also change to lactose free milk. Our bodies do need different types of fats and proteins. If you have problems in fat absorption and protein digestion, you may need to take some specialized supplements rich in medium chain triglycerides and (MCTs) and pre-digested proteins (peptides). Check with your doctor or a registered dietitian.

 

  1. MacKay D, Miller AL. Altern Med Rev. 2003;8:359-377.
  2. Oliver D, Griffiths R, Roche J, Sahota O. BMJ Clin Evid. 2010;2010.
  3. Holm L, Esmarck B, Mizuno M, et al. J Orthop Res. 2006;24:2114-2123.
  4. Braga M, Gianotti L, Vignali A, Carlo VD. Surgery. 2002;132:805-814.
  5. Pradelli L, Mayer K, Muscaritoli M, Heller AR. Crit Care. 2012;16:R184.
  6. Smedley F, Bowling T, James M, et al. Br J Surg. 2004;91:983-990.
  7. Weimann A, Braga M, Harsanyi L, et al. Clin Nutr. 2006;25:224-244.
  8. Fearon KC, Luff R. Proc Nutr Soc. 2003;62:807-811.
  9. Pasia M, Diet & Nutrition Guide; United Ostomy Association of America-201110.
    Ostomy Nutrition GuideUPMC Life Changing Medicine - 2017


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Many patients who require surgery are malnourished or unable to eat before or after the surgery. In these individuals, providing nutrition support, either by oral nutritional supplements or tube feeding, is necessary