Nutrition for perforated gastric ulcer. Postoperative diet menu for stomach ulcers

At peptic ulcer stomach and twelve duodenal ulcer perforation is a dangerous complication for human life and health. At the onset of the first symptoms, hospitalization is necessary and surgical care. During hospitalization after surgery perforated ulcer stomach and duodenum shows diet therapy. Following the instructions of the attending physician on the menu in postoperative period contributes to the reduction rehabilitation period and rapid normalization of digestive functions.

Symptoms of an exacerbation of an ulcer by perforation

Perforation in peptic ulcer - acute condition with the destruction of the walls of the stomach and duodenum. Occurs in patients with chronic course or in acute stage, in 60% of those infected with Helicobacter pylori. A trial ulcer is diagnosed in 2-10% of patients.

Clinical picture:

• acute and sharp and epigastric mesogastric region;
• "board-shaped" hard stomach;
• pallor;
• dry mouth;
• frequent breathing;
• slow pulse.

Medical care for perforation

The patient spends the acute stage with a complication in the form of perforation in a hospital. If the operation is not performed on time, perforation is fraught with peritonitis and death. When the surgeon confirms the diagnosis, the patient is urgently prepared for surgical intervention.

There are three types of surgery:

• suturing;
• excision followed by pyloroplasty and vagotomy;
• laser cauterization;
• resection.

A separate item - laser cauterization is more often used as preventive measure at risk of perforation. In rare cases, a laser is used for perforation. After cauterization of a stomach ulcer, patients begin to fully eat earlier than after surgical procedures, but you can only eat what is shown on a therapeutic diet.

In the postoperative period, antiulcer drug therapy is carried out. After excision of a perforated gastric ulcer, a patient is shown a special diet according to the varieties of the zero and first table. In addition, doctors recommend undergoing a course of physiotherapy. After the operation, the patient must observe bed rest for at least the first two weeks, half-bed rest for another month.

Nutrition after perforated ulcer surgery

The first 24 hours after surgery shows absolute hunger. Nutrition with vitamins after gastric surgery to remove perforated areas is administered through a dropper. Unloading and sparing attitude to the digestive organs is the basis of recovery. Functions gastrointestinal tract recover gradually, so they start with the lightest surgical diets with low calorie content and minimal salt content. Starting from the second day to the fourth, the patient is given tea with moderate temperature sugar and a rosehip broth. Drinks give one teaspoon every half hour. If the peristalsis has recovered, dietary nutrition is introduced in stages, gradually expanding the diet and introducing new products.

Diet after perforated gastric ulcer surgery important element in the complex of restoration and normalization of the gastrointestinal tract.

The rules of therapeutic diet therapy

The first two weeks after surgery on the stomach with a complication of an ulcer in the form of perforation is an especially important period, the diet is strictly adhered to, without overeating and not exceeding the norm of permitted foods. Excessive stress on the weakened digestive organs will cause a protracted recovery period. The damaged epithelium is weak at first, so the food should be neutral, non-aggressive, so that the mucous membranes begin to recover.

Products are selected according to the diet table number and their tolerance. The main principle is that they do not cause excessive release of hydrogen chloride, are easily digestible. Temperature regime serving hot first and second courses - 50 degrees, cold - 30-40 degrees.

Food is consumed in small portions, in accordance with the number of the recommended dietary table, from six to eight times a day.

The diet after surgery for gastric ulcer complicated by perforation depends on the patient's well-being and the dietary table prescribed by the doctor.

In the menu, depending on the table number, there are following products meals and meals:

• weak vegetable and meat (chicken, turkey, beef) broths;
• soups vegetable, meat, with the addition of butter or cream;
• wheat bread crackers;
• boiled, stewed, baked meat (turkey, chicken, veal) in the form of cutlets, soufflé, mashed potatoes, finely chopped cutlets;
• low-fat varieties of fish (pollock, hake) in a steamed, stewed form without skin;
• milk, cream are added to dishes during cooking;
• cottage cheese;
• kefir;
• yogurt;
• porridge is boiled to a mucus-like liquid consistency (semolina, oatmeal, rice, buckwheat);
• butter, olive, sunflower oils;
• coarse vegetables (potatoes, beets, carrots, broccoli, cauliflower) in steamed, boiled, baked form;
• green and black tea, loosely brewed;
• milk and fruit kissels;
• fruits in baked form, in compotes.

The diet after surgery and during any stage of gastric and duodenal ulcers should be made in accordance with this list of products.

Table No. 0 A

This diet therapy is prescribed on the fifth day after surgical manipulations on a perforated gastric ulcer, provided that the peristalsis has returned to normal. If the functions of the gastrointestinal tract have not recovered, continue the course of droppers. The duration of the diet of table No. 0 A after surgery for a perforated gastric and duodenal ulcer is from two to five days, depending on the patient's health status. Doctors recommend bed rest, the exclusion of stressful situations.

Nutritional value of the dietary table:

• ten grams of proteins;
• fifteen grams of fat;
• no more than two hundred grams of carbohydrates.

Main Products of Table No. 0A:

• oatmeal, semolina, rice porridge boiled to a slimy form with the addition of cream;
• weak, not rich chicken or turkey broth;
• jelly from pears, pumpkins;
• rosehip decoction.

Sample menu for the period of Table No. 0A

In the first days of eating, it is important to follow the doctor's instructions and diet. If you eat forbidden foods, inflammation may develop, the walls of the gastrointestinal tract will be irritated, and complications are possible.

It is allowed to eat only liquid dishes in small portions from six to eight times a day, two hundred grams per meal. They are guided by an approximate menu after surgery for a perforated ulcer, but they look at the patient's well-being. If any of the products causes pain, bloating or discomfort, they are temporarily canceled.

Menu for the first day

For breakfast, oatmeal is boiled in water or with the addition of a teaspoon of cream. It is allowed to drink a decoction of wild rose. Porridge is boiled until slimy liquid state, grits are ground before cooking.

For the second breakfast, a weak pear jelly is prepared. Wash down with weak sweet tea (half a glass).

Snack before dinner - dried fruit compote.

For lunch, they cook a weak broth on a chicken breast. Supplement with a decoction of wild rose (no more than half a glass).

For the second dinner, berry jelly is prepared.

For an afternoon snack, rice porridge is boiled to a liquid state (white rice is ground before cooking). Drink half a glass of sweet weak tea.

For dinner, a weak veal broth is prepared.

Second day diet

For the first breakfast, boil liquid semolina without milk. As a drink - weak sweet tea.

For second breakfast, veal broth is prepared. Wash down with half a glass of rosehip broth.

For a snack, cook liquid pumpkin jelly.

Before dinner, you can make a second snack with turkey fillet broth.

For lunch, pear jelly is prepared.

For the second dinner, a very liquid jelly is brewed. As a drink - sweet tea.

For an afternoon snack, they cook liquid dairy-free porridge from oatmeal.

For dinner, a weak turkey breast broth is suitable.

third day

For breakfast, cook very thin dairy-free rice porridge. As a drink - dried fruit compote.

For the second meal, pear jelly is prepared.

Have a snack with chicken breast broth, drink weak sweet black tea.

Before dinner, they cook jelly-like oatmeal porridge on the water. From drinks - half a glass of rosehip broth.

For lunch, veal broth is cooked.

For an afternoon snack, liquid pumpkin jelly is suitable.

As a snack, drink rosehip compote.

For dinner, pear jelly is cooked.

Sample menu for the period of Table No. 0B

The nutritional value of the dietary table for fats and proteins is increased to fifty grams per day. It is allowed to enter salt up to four grams and carbohydrates no more than 300 grams. At this stage of diet therapy, when restoring the work of the stomach after surgery on an ulcer, you can eat mashed food, lean meats and fish, and eggs are introduced. The duration of diet therapy at the discretion of the doctor is from two to four days, depending on the patient's state of health. During the period of rehabilitation and recovery of mucous membranes after surgery with complications of stomach ulcers according to Table No. 0B, the serving size is not more than 250 grams. Milk is rarely included during this period due to the risk of bloating and flatulence.

Meal plan for the first day

Cooked for breakfast steam omelet without milk. The drink is dried fruit compote.

For a snack, a liquid dairy-free rice porridge is prepared.

Before dinner, pear jelly is boiled.

For lunch, boiled chicken breast is mashed to a puree state. Sweet tea for dessert.

For the second dinner, boil one soft-boiled egg. Drink - rosehip broth.

For an afternoon snack, milk-free liquid oatmeal is brewed.

For dinner, boiled pollock is ground to a puree state. From drinks - tea.

Second day menu

For breakfast, they cook semolina porridge without milk, pear compote.

For a snack, pear jelly is prepared.

For the second snack, you can boil one soft-boiled egg, drink sweet tea.

For lunch, turkey breast broth is boiled, which is then mashed. You can drink dried fruit compote.

For an afternoon snack, an omelet is prepared from one steamed egg.

For dinner, they cook jelly from apples.

Diet Table No. 0

At the next stage diet food after surgery for perforated stomach ulcer nutritional value proteins are brought to one hundred grams per day, carbohydrates - up to three hundred grams, fats - up to seventy grams. Follow this table from two to four, depending on the patient's well-being.

First day menu

For breakfast, cottage cheese is rubbed with cream, and tea is used for drinks.

Ready for a snack baked apple, washed down with pear compote.

Before dinner, boil the cauliflower and rub it to a puree state.

For lunch - boiled chicken breast in puree form. The drink is tea.

For an afternoon snack, a steam omelette is cooked, washed down with a fruit drink of berries.

For dinner, pollock is crushed with a side dish of pumpkin puree.

Diet of the second day

For the first breakfast, they cook oatmeal with cream. For dessert pear jelly.

Applesauce is prepared for a second breakfast, and tea is made from drinks.

For lunch, turkey breast cream soup is cooked, mashed potatoes are served as a side dish.

For an afternoon snack, yogurt with a baked apple.

For dinner, boiled veal is ground with vegetable puree.

Menu of the third day

For tomorrow, boil a soft-boiled egg. For dessert, pumpkin jelly is made.

For a snack - kefir and one white cracker.

For lunch, boil the chicken breast, rub it and mix it with boiled broccoli puree. Drink - rosehip broth.

For an afternoon snack, they grind cottage cheese with a baked apple.

For dinner, pollock is steamed with mashed potatoes. Drink - pear jelly.

Sample menu for the period of Table No. 1 B

Diet according to Table No. 1 B after surgery for a perforated gastric ulcer begins in the hospital and continues at home for two to four months. In good health and normal functioning of the digestive organs, the diet is changed to table number 1. All food at this stage is served pureed, steamed, stewed, baked.

First day menu

For breakfast, rice porridge is boiled in milk, washed down with rosehip juice.

For a second breakfast, they cook pear kissel, one white bread cracker.

For lunch, soup-puree is cooked from chicken breast, potatoes, carrots. For dessert, tea with honey.

For an afternoon snack, an apple is baked in the oven, a drink is a rosehip infusion.

For dinner, steamed cutlets are made from halibut, and milk jelly for dessert.

For the second dinner, a glass of kefir.

Second day menu

For the first morning meal, a steam omelet is prepared from two eggs and milk, for dessert - pear jelly.

For a snack, yogurt is mixed with a baked apple and a teaspoon of honey.

For a lunch meal, a turkey soufflé is prepared, boiled beetroot puree is served as a side dish, and half a glass of rosehip broth is served for dessert.

For the second snack, milk buckwheat porridge is cooked with one white cracker.

For an evening meal, a steamed veal cutlet is prepared, garnish - stewed mashed carrots, a glass of tea.

Menu of the third day

For the first breakfast, they cook milk semolina porridge with butter, for dessert, dried fruit compote.

Second breakfast 1 baked apple and cottage cheese mashed with cream.

For lunch, turkey, carrot, and potato soup is cooked. Milk pudding for dessert.

For an afternoon snack, kefir and one white cracker, one soft-boiled egg are served.

For dinner, pollock is baked in the oven and served with steamed cauliflower. Morse.

For a snack before bed, you can have a glass of yogurt.

Diet table number 1

The diet at this stage of the patient's recovery after surgery is expanding, fruits, vegetables, and cheeses are added.

In the forbidden menu remains:

• seasonings;
• acute;
• fried or baked to a crust;
• any alcoholic drinks;
• sour fruits;
• marinades;
• sweet pastries;
• carbonated drinks;
• coarse vegetables (white cabbage, radish, onion, sorrel);
• smoked and canned;
• fatty;
• coarse cereals (barley, corn);
• coarse meat with fibers;
• ice cream;
• chocolate products;
• fried or hard boiled eggs.

List of dishes of the first day of the diet

For breakfast, they make a curd casserole with pears, sweet tea, a piece of mild cheese.

For a snack, fruit jelly is cooked from apples.

For lunch, chicken breast soup with potatoes and carrots, rosehip infusion and white cracker are allowed.

For an afternoon snack, a steam omelet with milk is prepared.

For dinner, steamed pollock cutlet, stewed zucchini.

Diet for the second day

Milk soup with noodles, dried fruit compote.

For a second breakfast, boil a soft-boiled egg, yogurt.

For lunch, buckwheat porridge, steamed turkey cutlet, tea.

For an afternoon snack, a glass of kefir with one cracker is suitable.

For dinner, cook milk soup from cereals, a baked apple.

After discharge from the hospital, the patient continues to adhere to the prescribed diet. If prohibited foods are not excluded, the organs of the gastrointestinal tract (gastrointestinal tract) after surgery on a perforated stomach ulcer will heal more slowly or an inflammatory process will begin. For exclusion re-development disease is worth and after recovery to adhere to the correct healthy diet.

Perforated stomach ulcer refers to complications of peptic ulcer and occurs as a result of the progression of destructive processes in chronic ulcer. Perforation is facilitated by a sudden increase in intra-abdominal pressure (for example, lifting weights or abdominal trauma), stress on the digestive organs (alcohol, roughage), and stress.

Visually, a through defect is noted in the wall of the stomach, as a result of which the contents of the stomach enter the abdominal cavity, act as an irritant and lead to peritonitis (serous-fibrinous and purulent). With perforation of gastric ulcers, it develops rapidly (in 2-3 hours).

The body's primary reaction to perforation is pain shock(sharp, dagger pain in the epigastrium) and loss of consciousness is possible. Due to the spread of exudate, pain quickly spreads throughout the abdomen and radiates to the supraclavicular region to the left. Often there is nausea and reflex vomiting, dry mouth and weakness. Ulcer perforation is an indication for urgent surgery, and the choice of method depends on many factors and indications. Conservative treatment is possible only as a temporary necessary measure in a very serious condition of the patient and in the case of covered perforation, when there are no symptoms peritonitis .

The operation most often comes down to suturing perforated ulcers. With the use of modern medical technologies, it is possible to conduct video endoscopic operations, as well as suturing the hole with the help of the device Endo Stitch.

The suturing area is peritonized with an omentum, and the tightness of the sutures is checked by forcing air through the probe. The disadvantages of this method of operation is the possibility relapse ulcers in 50-60% of patients, incomplete sealing of sutures and narrowing of the lumen of the gastric outlet. More radical operations are gastric resection, vagotomy and excision of the ulcer with a stomach-draining operation.

Resection of the stomach is performed with a long history of ulcers, callous ulcers and re-perforation. Resection requires the absence of widespread peritonitis. The postoperative period includes therapeutic nutrition.

Diet after surgery

Nutrition begins with surgical Diet No. 0A , 0B , 0V . They provide unloading and sparing of the stomach, prevent the appearance of bloating, because they contain minimal amount food nutrients. Perforated gastric ulcer and the condition after its surgical treatment is serious illness and requires a gradual restoration of gastric function. The diet during this period should contain easily digestible products and gradually increasing amounts of proteins, fats, and carbohydrates, while severely limiting salt intake.

On the first postoperative day after the operation, hunger is indicated, and from the second day, warm sweet tea (250 ml) and rosehip infusion (50 ml) are introduced. They are given every 20 minutes in a teaspoon. From 3-4 days with normal peristalsis, the patient is prescribed Table No. 0A (It is complemented by two soft-boiled eggs). A week after the operation, a transfer to Table number 0B , and after 9 days - No. 0B .

• Table №0A is the lowest calorie and contains only 10 g of protein, 15 g of fat and up to 200 g of carbohydrates. The diet consists of mucous decoctions, into which cream is introduced, weak meat broth, berry jelly (or jelly), rosehip infusion and juices. Food only in liquid form in portions up to 250 g, meals are organized 7-8 times a day. Puree-like dishes, drinks with gas and whole milk which can cause bloating.
• Table №0B already contains more essential nutrients (50 g of protein and fat each), no more than 4 g of salt and 250 g of carbohydrates. Food is allowed in liquid and puree form, and the volume of servings increases to 400 g. lean meat and fish.
• Table number 0 B already contains 80-90 g of protein, 320 g of carbohydrates and 70 g of fat. The amount of allowed salt is also increased (6-7 g). Puree-like food is consumed 5-6 times a day. Additionally, mashed meat and fish, soups and mashed creams, mashed cottage cheese with cream, kefir, yogurt, baked apples, fruit and vegetable puree, white crackers in a small amount (up to 75 g).

The duration of each of these diets is on average 2-4 days, which depends on the volume of the operation performed and the condition of the patient (they can be lengthened or shortened). Subsequently, the patient is transferred to (wiped version). Eating up to 5-6 times, its volume is 250 g of a pureed dish and a glass of liquid. Start eating on this diet in the hospital and continue at home. It includes:

• Pureed soups from cereals (oatmeal, semolina, rice, buckwheat). They add egg-milk mixture or cream, as well as butter. It is allowed to add mashed vegetables (potatoes, carrots, beets) and mashed meat to soups.
• Crackers from white bread in an amount up to 100 g.
• Meat and poultry in the form of a soufflé, and new dishes are added - steamed cutlets and dumplings.
• Fish in chopped form (cutlets, meatballs, dumplings) from cod, hake, pike pollock. Fish and meat dishes are consumed once a day.
• Potato, carrot and beetroot puree with cream or milk and butter is introduced, steamed vegetable soufflés can be prepared. vegetable dishes can be successfully replaced with baby food.
• Pureed cereals with the addition of milk and butter.
• Milk, fresh cottage cheese (mashed) with the addition of milk, milk jelly and cream (in dishes). With good tolerance - whole milk up to 4 glasses.
• Eggs are allowed (2-3 pieces) daily - soft-boiled or steam omelette, as an additive to soups.
• Berries in processed form - kissels, compotes, jelly. Do not eat fresh berries.
• Butter (butter and vegetable) - in ready meals. Sugar up to 40-50 g and honey.
• Weak tea with milk, milk jelly, carrot juice, diluted juices from berries, rosehip infusion.

This diet contains a physiological amount of protein (100-110 g), but it is replenished mainly due to milk proteins (more milk porridges, the amount of milk and cottage cheese).

Protein meat or fish dishes present in the diet once a day. The amount of fat per level physiological norms, but with poor tolerance (bitterness in the mouth, diarrhea, belching food), their number is limited to 60 g.

With good health, after 3-4 months, the patient is transferred to an unwashed version. This diet is physiologically complete and varied in terms of a set of products. Contains an increased amount of protein, the norm of fats and complex carbohydrates. simple carbohydrates limited in order to prevent the occurrence of dumping syndrome. Products are boiled or steamed, after which baking or stewing is allowed. In more detail, products and their methods of preparation will be discussed below.

Six months later, nutrition after a stomach ulcer and surgery no longer differs from normal nutrition, but mucosal irritants are excluded.

Approved Products

Diet after gastric ulcer surgery involves the use of:

• Soups on vegetable broth or weak meat broth (shchi, okroshka and borscht are excluded). In soups, cereals are well boiled and vegetables are finely chopped. As before, to improve the taste, egg-milk mixture, cream or butter are introduced into them.
• Dried wheat bread.
• Lean meat (beef, lamb, turkey, chicken) in the form of chopped steamed products (meatballs, meatballs, pates, meatballs). Soft meat and boiled tongue can be eaten in pieces.
• Lean fish minced or in pieces, with the skin removed. You can eat jellied fish, but use vegetable broth for pouring.
• Milk, cream (in dishes), cottage cheese, non-acid curdled milk and kefir. The choice of cottage cheese dishes is expanding - casseroles and lazy dumplings.
• Semolina, buckwheat and rice porridges are well boiled and semi-viscous. They are cooked on water and with the addition of milk.
• Butter and vegetable oil in ready meals.
• Mashed potatoes and puddings made from potatoes, carrots, cauliflower and beets.
• Weak tea with milk, juices from sweet fruits, jelly.
• Fruits only in thermally processed form (jelly, baked and mashed potatoes), compotes with mashed fruits.

Table of allowed products

Wholly or partially restricted products

• Dishes that irritate the mucous membrane and stimulate secretion are excluded: strong meat / fish broths, fried and stewed dishes, mushrooms, pickles and pickled vegetables, spicy and sour sauces, smoked meat and fish products, canned food, spices and seasonings;
• Dairy products with high acidity.
• Rye bread, puff and pastry products.
• White cabbage, radish, sorrel, tomatoes, cucumbers, onions.
• Millet, barley, corn and pearl barley, legumes, pasta.
• Sour fruits / berries.

Table of prohibited products

* data are per 100 g of product

Menu (Power Mode)

Rational nutrition after surgery allows you to quickly restore the function of digestion and is the prevention of relapses peptic ulcer . Its main principle is moderate sparing of the gastrointestinal tract, adherence to the regime and the exclusion of spicy, smoked and fried foods.

It is important to observe the methods of culinary processing of products and the volume of food consumed. The alternation of different protein and cereal dishes will make the diet varied. The issue of drinking milk is decided individually - if it is poorly tolerated, it is worth excluding whole milk and using it only when cooking.

With a perforated stomach ulcer in order emergency care very often a life-saving operation of suturing the perforated hole is performed.

Immediate results after this operation, as shown by the materials of the Institute. N. V. Sklifosovsky (Moscow), should be recognized as quite satisfactory in a significant percentage of cases. When a perforated ulcer is localized in the initial part of the duodenum or in the prepyloric part of the stomach, often after the ulcer is sutured, a relative narrowing of the lumen of the duodenum or stomach occurs, making it difficult for food to pass from the stomach to the duodenum. This circumstance necessitates the forced imposition of an unloading anastomosis of the stomach with a loop of the jejunum (gastroenterostomy).

When examining patients in the long term after suturing a perforated gastric ulcer, good results decreased to 0, satisfactory - to 7.7%, and unsatisfactory increased to 92.3%. Unsatisfactory results in the long term after suturing a perforated ulcer are due to a number of reasons. Among them highest value has a recurrent ulcer after a clear gap, or at the site of suturing, or outside this zone, a penetrating ulcer. Cancer may occur at the site of a sutured perforated ulcer. This complication occurs in 2-3% of perforated ulcers and usually occurs after perforation of callous ulcers. The time interval between suturing a perforated ulcer and the occurrence of cancer at its site varies from several months to several years. Sometimes, after suturing, late profuse gastroduodenal bleeding is observed.

In the long term after the operation in question, deformity of the stomach may develop: when the ulcer is located in the pylorus, along with narrowing of the exit from the stomach, in some cases there is an eccentric position of the pylorus in relation to the duodenum. Both of these complications disrupt the evacuation function of the stomach. In this group of patients, there is a feeling of heaviness in the pit of the stomach, frequent vomiting, belching rotten, abdominal pain.

Perigastritis, periduodenitis are also a frequent complication in the long term after surgery. One of the reasons for the development of these complications is the ingress of food particles into the abdominal cavity at the time of perforation of the ulcer. True, the operation itself on the abdominal organs often leads to the development of perivisceritis. All complications of a perforated ulcer of the stomach and duodenum can be divided into two groups:
1. Complications caused by the ulcer itself: recurrent ulcer, unhealed ulcer, new ulcer, ulcer penetration, bleeding from the ulcer, re-perforation of the ulcer, gastric polyposis, development of cancer at the site of the sutured ulcer.
2. Complications associated with the operation: stenosis of the outlet section of the stomach or the initial part of the duodenum, deformity of the stomach, perigastritis and periduodenitis, gastroduodenitis, diverticula of the duodenum and stomach (I. I. Neimark, 1958).

Despite some shortcomings, the above classification is useful, as it helps to better understand the pathogenesis of late complications after suturing a perforated ulcer. All late complications after suturing a perforated ulcer of the stomach and duodenum, caused by an ulcer, they are first subject to conservative treatment, and if the last repeated operation is unsuccessful, resection of the stomach. As for the complications associated with the operation, some of the complications are subject to surgical treatment: stenosis, deformity of the stomach, diverticula of the stomach and duodenum, and others - to therapeutic treatment and physiotherapy (gastroduodenitis, perigastritis and periduodenitis).

Gastroenterostomy as the main operation for peptic ulcer of the stomach and duodenum is currently used extremely rarely, since the massive experience of using it for over 30 years has discredited it: in the near future, after the imposition of an anastomosis, many patients experience significant relief, and then most of symptoms of peptic ulcer disease recurs and even a new symptom complex appears, called "gastroenterostomy as a disease" (Pribran, 1923). The development of this symptom complex is based on the action of active gastric juice on the intestinal mucosa and often the development of a peptic ulcer of the intestine at the site of the anastomosis or near it. Patients complain of constant empty eructations, heartburn, occasionally vomiting, pain in the pit of the stomach, especially after eating.

Clinically and radiographically, the symptom complex of gastroenteroanastomosis is very close to that of duodenal stasis observed with organic changes in the duodenum and outside it, creating difficulties for its emptying.

Research G. L. Shapiro (1951) found that the spread and intensity of the most common form of "disease operated stomach" - gastrojejunitis depends on the degree of traumatization of the nervous apparatus of the body.

It is advisable to consider individual early and late complications after gastric surgery.

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Complications observed in the first days after gastric surgery include severe bleeding, divergence of gastric sutures with subsequent peritonitis, introduction of loops small intestines into the omental bag through the hole in the mesentery of the transverse colon made during the imposition of the posterior gastroenteroanastomosis, followed by infringement, the entry of the small intestines into the stomach cavity through the anastomotic opening. These complications require emergency operation. The last two complications are very rare; as for bleeding and divergence of sutures, they must be prevented by careful performance of operations.

One of the most dangerous, although infrequent early complications gastroenterostomy is the so-called vicious circle- circulus vitiosus. This disease often complicates anterior gastroenterostomy. On the 2-3rd day after the operation, debilitating persistent vomiting occurs with large amounts of liquid mixed with bile, accompanied by an extreme drop in the patient's strength. When examining the abdomen in the left hypochondrium, a colossally swollen stomach with a sunken abdomen is visible. Half of the cases end in death. Occasionally the vicious circle proceeds chronically.

The essence of the disease is explained in three ways. According to one opinion, the expansion of the stomach occurs due to the formation of a mechanical obstruction due to the valve-like kink of the efferent loop of the intestine. The contents of the stomach plus bile and pancreatic juice, having no outlet to the intestines, returns entirely back to the stomach. The leading segment of the intestine is full, the outlet is empty (Fig. 155). However, during operations performed for this complication, organic obstructions were often not found. Other obstruction was explained by spasm of the outlet segment of the intestine. Still others consider the vicious circle as the primary atony of the stomach.

Treatment consists in gastric lavage, mainly in the constant active suction of the contents of the stomach with a water-jet or electric suction device. Requires subcutaneous or intravenous administration of large amounts physiological saline sodium chloride. If the above measures fail to eliminate the vicious circle soon, they resort to surgical treatment, which consists in imposing an anastomosis between the leading outflow segment of the intestine.

Acute dilatation of the stomach, see below.

Anastomosis is an inflammatory process in the area of ​​the gastrointestinal anastomosis, usually accompanied by perianastomosis, often with the formation of an infiltrate and deformation of the anastomosis. Symptoms: acute pain and vomiting due to a delay in the passage of the contents of the stomach into the intestine. Often, a second laparotomy, dissection of adhesions, and anastomosis between the afferent and efferent loops of the anastomosed intestine or a second gastroenteroanastomosis is necessary.

Fistulas of the stomach and duodenum are formed shortly after the operation when the gastric sutures diverge and the resulting abscess is opened to the outside. Gastric and intestinal fistulas sometimes close spontaneously, in other cases, surgical intervention is required, which consists in excising the fistula and sewing up the hole in the stomach.

The narrowing of the gastrointestinal anastomosis develops, apparently, as a result of contraction of the cicatricial ring that forms around the anastomosis or after the healing of a postoperative peptic ulcer. Rarely observed.

The function of the gastrointestinal anastomosis is also adversely affected by extensive postoperative adhesions.

Postoperative peptic ulcer occurs after gastric surgery for ulcers, but not cancer, and is usually a complication of gastroenterostomy, rarely - resection with anastomosis. It is rare for an ulcer to develop soon after surgery, usually after several months or years. A peptic ulcer is located in the area of ​​the anastomosis or at its edge on the outlet loop, often accompanied by the formation of an infiltrate, progresses rapidly and has a tendency to perforation. Sometimes a fistula is formed, communicating the stomach with the transverse colon, making possible direct entry of food from the stomach into the large intestine and causing fetid belching, fecal vomiting and diarrhea. Communication of the stomach with the transverse colon may be direct or carried out through the small intestine.

The occurrence of a peptic ulcer is promoted by the high acidity of gastric juice and a suture made of non-absorbable material, when gastric juice enters the channels of the suture.

The symptoms are the same as those of a stomach ulcer, with the only difference being that pain point is located below, pains are especially strong, come late, the infiltrate is sometimes probed. The diagnosis is confirmed by X-ray examination. Spontaneous healing of peptic ulcer is observed, but infrequently.

Initially, therapeutic treatment should be tested, especially resort treatment (Zheleznovodsk). In case of failure, they resort to surgical intervention, which consists in degastroenterostomy or, better, in a wide resection of the stomach, including a bowel loop with anastomosis.

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Peptic ulcer of the stomach has many unpleasant and dangerous consequences. One of them is perforation ulcer defect walls of the said organ. As a result, gastric contents are poured into the abdominal cavity, which can lead to the development of peritonitis (inflammation of the peritoneum), life threatening person.

This dangerous condition is called a perforated stomach ulcer and requires mandatory urgent surgical intervention. The causes of occurrence are chronic and acute stomach ulcers. Certain factors contribute to the perforation of the organ wall:

• lack of treatment for an exacerbation of an ulcer;
• gross violations of the diet;
• severe overeating;
• frequent stressful situations, constant mental and mental stress;
• heavy physical exercise and increased pressure inside the abdominal cavity;
• long-term use of glucocorticosteroids and salicylic acid preparations.

Most of all, ulcers located on the anterior wall of the stomach in the pyloric and prepyloric sections are prone to perforation.

Signs of perforated pathology of the stomach

Symptoms of a perforated ulcer and their severity depend on clinical form perforations. She may be:

• typical (into the free cavity of the peritoneum; including covered);
• atypical (into the space behind the peritoneum, between its sheets, into the interadhesion area).

The classic picture of the signs of a perforated ulcer is observed with perforation into the free abdominal cavity, which occurs in 90% of cases. It has 3 periods:

• primary "abdominal shock" (chemical inflammation);
• latent period (bacterial);
• diffuse purulent peritonitis.

Each of the periods has its own special symptoms. The phase of primary shock, lasting 6-10 hours, is characterized by the appearance of a sudden sharp "dagger" pain in epigastric region, often diverging along the phrenic nerve to the zone of the right shoulder, shoulder blade and outer part of the neck.

Outwardly, a sick person looks pale, haggard, with sunken eyes. characteristic feature- forced immobile position of the body, lying on its side, with legs brought to the stomach. Breathing is shallow and frequent, on the forehead cold sweat. "Board-like" tension of the abdominal muscles, which is not involved in the act of inhalation and exhalation.

The phase of bacterial peritonitis is also called the period of imaginary well-being. There is a decrease in the symptoms of pathology, the cessation of pain. The face becomes normal color, pulse and respiration normalize. When palpated, pain remains in the epigastric region and signs muscle tension belly.

After 12-24 hours from the moment of perforation, a picture of diffuse peritonitis unfolds. Symptoms return with new force the patient's condition worsens. Pain increases sharply, there is repeated vomiting, nausea, hiccups. Breathing is frequent and shallow, the pulse quickens, body temperature rises, the stomach swells.

Ulcer Therapy Methods

Perforated gastric ulcer of any shape and localization is an absolute indication for urgent surgical intervention. Therefore, when people, having got to the hospital with the indicated diagnosis, ask if the operation is mandatory, there can be no other answer than in the affirmative. And the sooner it is done, the better the prognosis and the lower the likelihood of complications.

Treatment without surgery is carried out in extreme cases when a person is categorically against surgery. It consists in the constant aspiration of the contents of the stomach through a probe against the background of intravenous administration. in one- saline solutions and antibiotics. The effectiveness of this method is possible on the most early stages the development of the disease, when the contents of the stomach did not have time to spill into the abdominal cavity. But often these activities only waste precious time and do not give an effect. For this reason, in the end, the person agrees to the operation, but it happens that it is already too late.

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Treatment for prehospital stage if a perforated gastric ulcer is suspected, it includes intravenous infusions of saline solutions, drugs that narrow blood vessels, oxygen inhalations. Narcotic painkillers should not be administered, as they "lubricate" the true picture of the disease. For this reason, an incorrect diagnosis in a hospital can be made. Before the operation, the gastric lavage is carried out using a probe to remove all its contents.

In surgical treatment, methods are used:

• suturing perforation;
• removal of part of the stomach (resection);
• excision of the ulcer with vagotomy (dissection vagus nerve).

Usually, operative access to the organ is carried out by laparotomy. If the necessary equipment is available, it is possible to perform operations endoscopically, under the control of a videoscope, through several holes in the abdominal wall, without a wide cut. If diffuse peritonitis and an intra-abdominal inflammatory process are detected during the course, they proceed to laparotomy.

Choice operational method is carried out in accordance with the patient's condition, his age, type of ulcer, the presence of concomitant diseases, time from the beginning of the perforative process. Any chosen method is aimed at curing the patient and saving his life.

Perforation suturing is used if more than 6-12 hours have passed since the onset of its formation, in young people with a recent gastric ulcer, in the elderly, with a general serious condition of a person.

Removal of part of the stomach (resection) is performed when:

• a long-standing ulcer that cannot be cured with medication;
• detection during the operation of an old ulcer that cannot be sutured;
• suspicion of malignancy of the ulcer;
• perforation of several ulcers at the same time.

Treatment after surgery includes:

• reception antiulcer drugs(Kvamatel, Zantak; Maalox, Almagel);
• application antibacterial agents(Ampioks);
• taking proton pump blockers (Omez);
• intravenous administration of solutions to improve microcirculation and wound healing (Trental, Actovegin, Reopoliglyukin, Solcoseryl).

After completion by any of the selected methods, sanitation is performed and the outflow of the emerging inflammatory fluid from the abdominal cavity (drainage) is ensured. Sometimes they put two probes: in the jejunum - for nutrition, in the stomach - for decompression.

In the postoperative period, early activation of the patient, breathing exercises and exercise therapy are recommended. Contribute to the restoration of health walks on fresh air rest, exclusion of physical activity and psycho-emotional stress, good nutrition according to the rules of the necessary diet.

With the help of modern methods of laser therapy, scars formed after surgical intervention are removed. Such events can only be carried out with complete healing. postoperative wound, in the absence of any complications, after control gastroscopy.

Features of the diet after surgery

Often, the patient's relatives have a question about what kind of nutrition is indicated after the removal of a perforated ulcer. On the first day, it is only allowed to drink water from a spoon in a small amount, the next day they give 200-250 ml of liquid food (porridge). On the third day, the volume of food is 500 ml, then it increases to 1 liter.

After 7 days, the patient is transferred to the main diet, similar to the treatment table used for exacerbation of gastric ulcer. She represents diet table No. 1a according to Pevzner. A week later, they switch to diet No. 1b, and then, after 10-12 days, to table No. 1, which must be followed for 8-12 months.

When eating in accordance with diet No. 1a, food is consumed in boiled, mashed, steamed, maximally liquefied form. All vegetables, bakery, sour-milk and confectionery products, raw fruits, spices, snacks, carbonated drinks, coffee are excluded.

When switching to diet No. 1b, steam cutlets, jellied fish, a baked apple or grated raw are added. treatment table#1 is not as strict as #1a. It allows the use of non-rigid meat and fish in pieces, wheat bread made from premium flour, boiled and mashed vegetables, slightly acidic kefir, cottage cheese, yogurt. The methods of cooking remain the same - boil, stew, steam, wipe tough food.

Complications of the disease and prognosis

The earlier an accurate diagnosis of a perforated stomach ulcer is made, the higher the likelihood of getting rid of it. serious condition. With the right timely diagnosis(in the first 12 hours) and carrying out the necessary surgical treatment, the prognosis is favorable.

Complications after surgery develop infrequently and can be presented:

• bronchopneumonia;
• purulent processes (abscesses under the diaphragm, between intestinal loops, in the subhepatic space);
• violation of the exit of food from the stomach;
• intestinal obstruction;
• bleeding (gastric or abdominal).

Each of these conditions, with any degree of symptom severity, requires careful treatment and, if necessary, reoperation.

Prevention of bronchopneumonia is facilitated by washing the trachea and bronchi, removing fluid from pleural cavity, early activation of the patient and breathing exercises. In case of violation of the passage of food through the stomach, all contents are removed from it through the inserted probe. At the same time, they fight slowing down of the intestines, giving a large number of fluids and intravenously injecting proteins and electrolytes.

If gastric obstruction persists, gastroscopy is performed to detect the cause of the disruption of the stomach, a possible mechanical obstruction that arose during the operation or as a complication, and to resolve the issue of the need for repeated surgical intervention.

An unfavorable outcome is usually observed as a result of a person's late seeking medical help, when symptoms are overt. Deaths occur due to diffuse purulent peritonitis, postoperative pneumonia and concomitant severe diseases. IN last years mortality among people diagnosed with perforated ulcers in surgical treatment has decreased significantly to 5-7%.

Long-term complications operations depend on its type and the correct choice of method. Re-perforation of the gastric wall occurs in less than 2% of operated people.

The purpose of our site is, first of all, to educate readers in the field of gastroenterology. We want to protect you from possible errors occurring with self-treatment, help to recognize the onset of diseases. This in no way replaces the need for expert advice and accurate diagnosis. Treat the patient according to his individual features and only a doctor should control the course of the disease!

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Peptic ulcer is a chronic pathology, which is characterized by the appearance of defective formations on the mucous membrane of the organ. In the early stages of therapy, medications. In the event that this does not give a positive effect, the patient is prescribed surgical treatment for gastric ulcers. The operation is carried out in urgently if the patient has internal bleeding or breakthrough defective education.

Today, several types of surgical measures are used to treat peptic ulcer. We will look at cases in which gastric ulcer surgery is necessary, and we will tell you how the procedure is performed.

Indications for intervention

Relatively recently, it became known that the bacterium Helicobacter pylori causes stomach ulcers. For this reason surgical intervention not used as often as before.

When a disease is detected, doctors first prescribe therapy medications, which in most cases give positive effect. But still, sometimes you have to turn to operational actions.

When surgery is needed urgently:

• internal bleeding that cannot be stopped by other means;
• perforation (perforation) of the ulcer;
• critical vasoconstriction in the stomach due to an ulcer.

IN planned Surgery is performed for the following indications:

• no healing effect drug therapy;
• high risk of developing cancer.

For chronic ulcer

Often patients are ready to do everything to prevent surgical intervention. Someone endure severe pain, believing that he will "let go soon", the other takes painkillers that are dangerous in his condition. But the paradox is that it is precisely such a delay that makes it impossible to postpone a visit to the surgeon.

The gastroenterologist will advise you to prepare for surgery with the following diagnoses:

• Pyloric stenosis. It is considered a complication of an ulcer and manifests itself in the narrowing of the area through which food enters the stomach. In the process of development of the pathology, constant vomiting is observed, the masses have a bright bad smell, the weight of the patient decreases.
• Bulb duodenal stenosis accompanied by heaviness in the abdomen, pallor of the mucous surfaces and skin, heartburn and belching with a rotten taste. The difference with this species is that vomiting occurs quite rarely. Over time, duodenal stenosis leads to paralysis of the diaphragm and respiratory arrest.
• Penetration (penetration) of the ulcer into other organs of the peritoneum. Expressed by radiating pain in the affected area (often in the back or up), which is not associated with meals. The disease goes through 3 stages: an ulcer grows through the entire wall of its organ; a spike is formed between the affected organ and the healthy one; ulcer penetrates into a new organ.
• The occurrence of adhesions, polyps, tumors requiring surgical intervention.
• Ulcer perforation.

Additional indications for gastric surgery include inefficiency conservative treatment And sharp deterioration the patient's condition.

With a perforated ulcer

Perforation (perforation) of the ulcer is expressed by the appearance of a lumen in the wall of the stomach. The size of the hole does not exceed a few millimeters, however, it poses a serious threat to the life of the patient. The patient's condition is characterized as widespread peritonitis - the strongest prolonged pain, pressure decreases, increased sweating and pallor are observed.

Measures to remove perforation are of 2 types: suturing and resection.

If no more than 6-7 hours have passed since the perforation of the ulcer, suturing is performed. The closure operation preserves the shape and size of the stomach. After rehabilitation, a person can return to his former life. That is why, when the first signs of perforation appear, in no case should one hesitate.

Resection of the stomach is one of the radical life-saving measures. As a result, the affected part of the organ is excised and then stitched together. After it, a disabled group is established for the patient. It is prescribed for purulent peritonitis (more than 7-12 hours after perforation).

After 7 hours, the patient feels relief, the abdominal muscles are smoothed, breathing is restored. However, against the background of a visible retreat of symptoms (a person stops experiencing pain, his tongue darkens, an attack of euphoria is observed), almost irreversible processes begin inside the body. The contents of the stomach have already entered the abdominal cavity and caused severe intoxication.

And if at this stage the patient is not given medical care, can be guaranteed death, since after 12 hours of perforation it goes to acute intoxication. There is incessant vomiting, and as a result, dehydration, body temperature rises to 40 degrees. The person stops responding external stimuli, stop working excretory system. As a rule, at this stage it is already impossible to help.

If perforation of the ulcer is accompanied by bleeding or stenosis (the lumen narrows and food cannot enter the stomach), then the ulcer is resected with stem vagotomy.

Preparation for the procedure

Preparation for gastric ulcer surgery consists in the maximum cleansing of the organ. If the operation is performed as planned, the patient is recommended to follow a certain diet a week before surgery, which consists in the rejection of fatty, smoked, salty and spicy foods. You should also refrain from carbonated and alcoholic drinks.

Eat low-calorie, wholesome foods. It includes dietary meat, fruits and vegetables. The day before the upcoming operation of the ulcer, the patient is recommended to exclude solid food from the diet. You can drink sweet tea, jelly, compote and so on. In a few hours Before the operation it is forbidden to drink even water. And immediately before surgery, the intestines are cleansed with an enema.

If the operation is planned, 3-5 days before the procedure, the patient needs to pass necessary tests: general analysis urine and blood, ECG, fluorography, x-ray of the stomach and others prescribed by a doctor.

Operation types

Peptic ulcer of the stomach is operated on in various ways.

The appropriate method is determined by the doctor, taking into account the results of the examinations.

suturing

This method is mainly used with perforated stomach ulcer. The operation causes almost no complications.

Surgical intervention occurs as follows:

1. The doctor cuts the abdominal cavity and with the help special device pumps out excess fluid.
2. Next, the specialist finds the place of perforation and limits it with sterile gauze wipes.
3. The perforated ulcer is sutured with a transverse suture.

The purpose of suturing is to narrow the lumen and preserve the natural shape of the organ.

It is very important that the operation is carried out qualified specialist. This is due to the fact that it must be successful the first time, otherwise the risk of complications increases significantly.

Resection

Operating method, implying full or partial removal stomach. The procedure is prescribed in extreme cases in critical condition patient.

Gastric resection has many disadvantages:

1. The patient has to give up physical activity for life.
2. Throughout life, a person must eat right, without eating harmful foods.
3. With this type of surgery, a long period of time is required for recovery.
4. High risk of getting serious complications after surgery.

The operation to remove the ulcer takes place under long-term general anesthesia. Also needed artificial ventilation lungs. The doctor removes the affected area of ​​the stomach, then stitches it in such a way as to preserve the natural shape of the organ as much as possible.

If the surgical intervention was successful, after the end of the operation, the patient is allowed to stand up only after 10-14 days.

Vagotomy

Surgery involves cutting the vagus nerve. use with chronic course peptic ulcer, which is not amenable to medical treatment.

Vagotomy is performed on open body as well as laparoscopically. The doctor cuts the nerve that contributes to excessive production of acid and imposes cosmetic seam in places of punctures or incisions.

Among the shortcomings of the method, adhesions after surgery are distinguished, which occur very often.

Endoscopy

This method is used if the patient is diagnosed duodenal ulcer.

The doctor inserts a rubber tube into the patient's mouth, brings it to the right place and cauterizes the defective formations with a laser.

The type of surgical intervention depends on how the operation is performed (planned or urgently), as well as on the severity of the disease.

rehabilitation period

After the procedure, the patient stays in the hospital for some time. The length of stay depends on the type of ulcer surgery and the patient's well-being. To reduce the risk of side effects, drug therapy is prescribed.

In the postoperative period, the person remains under the supervision of doctors for a week. During this time, the sutures heal, after which they are removed. At discharge, the doctor gives the patient a memo in which the diet is indicated. It must be observed for at least two weeks (depending on the type of operation, the period may increase or decrease). The patient is recommended to eat liquid soups, viscous cereals. The main condition is room temperature food. Portions should be small (glass capacity).

In the first week, any physical activity is prohibited, after which light activity is gradually introduced. The postoperative period includes the release of the patient from work, the duration is set depending on the type of operation. In case it was carried out complete resection stomach, a person is assigned the third group of disability.

In no case should you eat cold or hot food. She provokes various complications after operation.

Possible consequences

Usually, the consequences occur if the patient did not follow medical instructions or asked for help too late.

The main complications include:

• postoperative internal bleeding;
• infection or rupture of the seam;

Diet after gastric ulcer surgery prerequisite for a quick recovery. In most cases, surgical intervention for this disease involves the elimination of the defect by sewing up the ulcer or removing part of the organ. Of course, after such a complex procedure, the patient needs a special diet.

Features of the diet after surgery

In order for the recovery process to proceed without undesirable consequences, at first the patient should follow the principles of sparing nutrition. He must follow a diet after gastric ulcer surgery, consisting of the following rules:

1. It is forbidden to starve. Food should not be taken for the first 48 hours after a perforated stomach ulcer. Then you need to eat often and in small portions.
2. Eat food slowly, chewing it well. This is necessary for the gradual normalization of the gastrointestinal tract and the restoration of digestion.
3. You should only eat dishes that are prepared by yourself. All products manufactured industrially are excluded from the diet. If you ignore this condition, then irritation of the gastric mucosa cannot be avoided.
4. Solid foods should be crushed to a mushy appearance. Food must be warm. The best option- boiled, steam food.

Advice! Drinking alcoholic beverages with a diagnosis of peptic ulcer is strictly prohibited. Drinking alcohol with a perforated ulcer can even lead to the death of a person.

It is possible to restore the work of the gastrointestinal tract after surgery only by strictly adhering to all the doctor's instructions on clinical nutrition.

Approved Products

What you can eat and drink is determined by the attending physician. But, as a rule, the diet after the operation of a perforated stomach ulcer includes:

• fat free dairy products;
• lean fish;
• soups (vegetable, dairy);

• mashed boiled vegetables;
• sparse cereals;
• steam cutlets from lean meat;
• fat-free cheeses;
• steam omelet;

• pudding, fruit jelly;
• cottage cheese casserole with honey;
• whole wheat bread.

Fresh fruits and vegetables should not be included in the diet for the first few months. They begin to use a little later, when digestion is completely normal after the operation.

In order not to call over-education stomach acid, fruits should not be hard and sour. In the postoperative period, it is allowed to drink the following drinks:

• non-acidic compote from fresh or frozen berries, dried fruits;
• unsweetened fruit drink;
• jelly;

• herbal teas, decoctions;
• weak black tea without sugar;
• tea diluted with milk.

Prohibited Products

There are many foods on the banned list. They usually have a negative effect on digestion and create an excessive load on the gastrointestinal tract, and can also cause excessive production of hydrochloric acid.

Therefore, from the diet for perforated gastric ulcer exclude any junk food. But you should also refuse such products:

• boiled and fried eggs;
• various sauces, mayonnaise;
• fatty meat broths and soups from them;
• spices, seasonings;
• confectionery;
• muffin, fresh bakery products;
• fast food products (fast food);

• salted crackers and nuts, seeds, chips;
• sausages;
• alcohol-containing and sweet carbonated drinks;
• grape;
• salo;
• mushrooms;
• legumes;
• citrus;
• cabbage;
• garlic;
• sorrel;

• canned food;
• kvass, coffee, strong tea;
• sweets, ice cream.

Advice! It is necessary to give up fruit juice and cocoa drink. It is better to replace them with medical mineral water without gas, for example, Essentuki, Borjomi.

Refusal to prepare dishes from the listed products will help to reduce the period of rehabilitation after radical therapy.

Allowed meals after surgery

Some patients believe that the amount of food included in the diet for stomach ulcers is very small, but this is far from the case. From allowed products you can cook completely balanced diet, which meets all the standards of the treatment menu after stomach surgery.

The diet is designed in such a way that the patient will not experience hunger and difficulties during the period of normalization of digestion. sample menu after surgery for a perforated stomach ulcer will look like this.

Breakfast options:

• steam omelet, natural yogurt, unsweetened tea;
• mashed porridge in milk diluted with water, chamomile decoction;
• mashed milk buckwheat, biscuits with dried fruit compote.

2nd breakfast options:

• fruit jelly, compote;
• chicken broth, green tea with the addition of honey;
• steamed eggs, toast with herbal tea.

Lunch options:

• mashed vegetable soups from cereals, grated pasta, non-sour jelly;
• pumpkin porridge, boiled fish, fruit compote;
• mashed potatoes or pumpkin, steam cutlets, warm milk.

Second lunch options:

• boiled chicken breast, kissel;
• pureed vegetable soup, biscuits, green tea;
• meat broth, mashed potatoes, compote.

• fat-free cottage cheese, biscuits, tea with rose hips;
• pumpkin puree, toast, vegetable decoction;
• fruit mousse or baked apple, compote.

Dinner options:

• baked fish fillet of low-fat varieties, a glass of skim milk;
• mashed potatoes with steamed cutlets, green tea;
• shabby fish soup with vegetables, yesterday's bread, weak tea.

The second dinner (optional) may consist of a glass of fat-free kefir or milk.

Advice! It should be noted that tea should be weak and without sugar, you can sweeten the drink with honey. Minimal salt should be added to meals.

Diet after surgery

Nutrition after gastric ulcer surgery should be balanced, steamed. This method of preparation should be followed long time and sometimes for the rest of your life.

The main goal of postoperative nutrition is minimum load on digestive tract and to protect the walls of the stomach. Therefore, the diet after surgery should be determined by a specialist. In any case, be sure to follow a diet. Otherwise, there is a high risk of recurrence of the ulcer.

1 Week

In the first week after the operation, the patient is shown rest and the most gentle nutrition. For the first time 24 hours you can not only eat food, but also drink water. With the permission of the doctor on the second day, you can drink half a glass of water. This amount of liquid is divided over the whole day.

If the recovery process is within the normal range, then during the third day you can drink 0.5 liters. warm water. On the fourth day, it is allowed to eat liquid food after gastric ulcer surgery. For example, low-fat turkey or chicken broth, liquid jelly.

The volume of food is calculated in glasses. So, a day is allowed to drink 3-4 glasses. On the fifth day, liquid semolina porridge on water, low-fat yogurt are introduced into the diet. In order for the body to recover faster, meat puree start to enter in 7 days after operation.

2-3 weeks

The further diet should consist of easily digestible and boiled foods. After a week, the following dishes are allowed:

• mashed potatoes;
• porridge in the form of mashed potatoes;
• vegetable soups in broth;
• steam cutlets;
• baked vegetables;
• curd soufflé;
• some toasted bread.

Advice! At this time after the operation, it is advisable for the patient to buy food for children in the pharmacy. Such products meet all the requirements of a dietary diet.

The attending physician should tell you what you can eat after gastric ulcer surgery during this period.

After 3rd week

Particular attention should be paid to the choice of products 3 weeks after gastric surgery. After all, it is for the first time that the digestive system gradually adapts to the new diet.

During this period, gradually begin to add other products. The menu includes almost all allowed products. Special attention is paid to dishes enriched with animal proteins: low-fat cheese, low-fat dairy products, chicken meat, eggs, fish.

If the recovery passes without complications, then after 2-3 months the use of non-acid pureed berries and fruits is allowed. However, it is necessary to adhere to dietary nutrition for a long time. You can expand the menu in a year if the rehabilitation process is proceeding favorably.

Thus, after surgical treatment of peptic ulcer, nutrition correction is required, as well as compliance with all doctor's recommendations. Only with favorable development can you return to your normal diet 2-3 years after the operation.