24 04 2023

Nutrition following liver and pancreas surgery

Assistant Dr Marija Đukanović, anaesthesiologist

Following surgery on the liver or pancreas, patients frequently inquire about the necessity of modifying their preoperative dietary regimen. During the patient’s hospital stay, dietary requirements are overseen by physicians. If the patient’s energy demands cannot be fulfilled by enteral nourishment in the initial days, a distinctive form of nutritional therapy is administered. The patient is instructed to consume oral supplements in the form of beverages that comprise a quantity that satisfies the daily requirements for macronutrients (mainly proteins), micronutrients, and vitamins. In circumstances where sufficient energy consumption cannot be achieved through enteral feeding, supplemental parenteral nutrition is introduced via intravenous infusion of sugars, amino acids, and fats. The parenteral mode of nutritional therapy is only employed during the patient’s hospitalization and until full projected energy intake through the alimentary canal cannot be achieved. After hospital discharge, it is imperative to seek counsel from a dietician or physician to tailor a unique dietary plan for each patient. An appraisal of the patient’s nutritional status is also essential to determine whether the patient is at risk of malnourishment or is already malnourished. Based on this evaluation, an individualized diet is prescribed.

During the initial postoperative period following liver resection, consuming food can pose difficulties due to the predisposition towards hypoglycaemia. To manage this situation, a diet that comprises a high proportion of carbohydrates and proteins is advised.

In addition, after liver surgery, it is generally recommended to adhere to the following dietary guidelines:

• a diet rich in proteins from sources such as poultry and beef
• consumption of medium-chain fatty acids, which are most abundant in coconut and palm oil, butter, milk, cheese, and yoghurt
• intake of omega-3 fatty acids from sources such as olive oil, avocado, peanut butter, and salmon
• avoid fried foods and high glycaemic index foods like industrial sweets, pastries, and white bread
• avoid raw or undercooked foods like sushi and shellfish to minimize the risk of introducing bacteria that can cause severe illnesses in individuals with liver diseases.

Following surgeries on the pancreas, particularly after a complicated resection necessitated by a tumour located in the pancreatic head, there is a significant alteration in dietary habits. It is not uncommon for patients to experience a reduction in appetite or to express dissatisfaction with changes in food flavour.

Here are some possible guidelines on nutrition after pancreatic surgery:

• following surgery, a liquid diet is typically advised initially, with solid foods gradually introduced
• a diet rich in protein is important, and high-protein foods should be included
• it’s recommended to reduce the consumption of high-fat foods and avoid fried foods altogether
• foods with omega-3 fatty acids (such as olive oil, avocado, peanut butter, nuts, and salmon) are recommended in moderation. It’s best to avoid high-glycaemic index carbohydrates, like industrial sweets, white bread, and pastries, as consuming too many can lead to high blood sugar levels and associated symptoms
• eating fruits and vegetables is encouraged (at least one small bowl per day), though fresh produce may need to be avoided for the first few days after surgery before being gradually reintroduced based on individual tolerance
• eating smaller, more frequent meals (around 6-8 per day, including three main meals and three snacks) can help with digestion and prevent bloating and nausea. There should be at least three hours between meals
• drinking enough fluids is crucial (around 2 L of water per day is recommended)
• it’s best to avoid consuming beverages during or immediately after meals, and waiting at least an hour is advised
• consuming high-calorie, protein-enriched drinks like smoothies or nutritional supplements as a snack between meals may be helpful
• a prescribing physician may recommend taking pancreatic enzyme tablets, with the dosage tailored to the individual
• if a patient experiences frequent diarrhoea due to malabsorption following liver or pancreatic surgery (which is not uncommon), their doctor should consider adding more vitamins to their diet, especially fat-soluble vitamins (A, D, E, and K), as well as water-soluble vitamins (such as B-complex vitamins and vitamin C)
• it’s crucial for patients to walk for at least 30 minutes a day to aid in digestion
• keeping a food diary is one of the most important measures in the first few months after surgery; patients should record the quantity and type of meals they eat, the timing of meals, specific symptoms they experience after eating certain foods, the number of stools they have each day, the appearance of their stools, their blood sugar levels (if necessary), and their body weight measured at 7-10-day intervals
• this information helps the patient’s dietitian or doctor to tailor an appropriate diet plan for their individual needs.