Best diet plan for 15 days after rectal ESD surgery

The core of the best diet for the 15 days after rectal ESD surgery is to "dynamically adjust in two stages, based on low residue, coolness, easy absorption, and high nutrition, and completely avoid hard, residue-rich, and irritating foods." The first 7 days (1-7 days after surgery) are mainly clear liquids, and liquids transition to less residue and semi-liquids. After 8 days (8-15 days after surgery), soft and rotten soft foods with less residue can be gradually added. The core goal is to reduce intestinal burden, avoid wound friction and bleeding, and ensure nutritional supply to speed up healing.

Not long ago, I met a 42-year-old patient in the outpatient clinic. He had a 2cm adenoma on his rectum and underwent ESD. The postoperative recovery was going smoothly. On the fifth day, he made celery and pork dumplings at home. He thought that it had been almost a week and he would be fine after eating them. However, he passed a small amount of dark red bloody stool that night. He was so scared that he ran to the emergency room overnight. Fortunately, the amount of bleeding was not large, and he was fine after two days of conservative observation. Don’t underestimate the coarse fiber residue. The rectal wound after ESD is like a newly scabbed knee wound. Not to mention hard vegetable residue, even slightly rough food residue may break the tender scab and cause bleeding.

Currently, there are actually two different clinical tendencies in diet control during these 15 days. One is the "strict residue control group", which advocates that except for liquids and semi-liquids that are completely free of residue, any food containing dietary fiber should wait until 3 weeks after the operation, even boiled vegetable leaves, to minimize the risk of wound friction. This advice is generally given to patients with relatively large wounds (more than 3cm), bleeding during the operation, or patients with diabetes who have slow healing. The other group is the "moderately relaxed group". They believe that as long as the wound is less than 2cm and there is no bleeding and abdominal pain in the first 3 days after the operation, a small amount of peeled pumpkin, carrot puree, and even chopped vegetable leaves boiled until soft and rotten can be added about 10 days after the operation. Appropriate supplementation of vitamins can promote healing, and there is no need to strictly adhere to the standard.

In fact, there is nothing wrong with either statement. You can flexibly adjust it according to your actual situation. When you are not sure, just ask the bedside doctor. There is no need to worry about who is right.

Let’s talk about the diet in the previous week. In the first three days after the operation, you can basically only eat clear liquids, which are rice soup, thin lotus root starch, filtered vegetable juice and apple juice. If you feel hungry and can’t bear it, you can take the enteral nutrition powder prescribed by the doctor. It has a light milky aroma. It will make you fuller than just drinking rice soup, and it can also supplement enough protein. Don't listen to what the elders at home say about drinking bone soup. The soup is full of fat and purine and has very little protein content. Drinking it will cause flatulence and diarrhea, which will put a burden on the intestines.

After 4 to 7 days after the operation, if there is no bleeding, flatulence and defecation, you can slowly transition to a semi-liquid diet with less residue. Steamed egg custard, sticky white porridge, and rotten noodles can be arranged. Don’t eat too much at each meal. Just be 70 to 80% full. You can eat five or six meals a day. Take a bite when you are hungry. Don’t bear it.

After the 7th day after surgery, if everything is normal, you can slowly add more "real" things. For example, you can eat a small amount of lean meat porridge, steamed noodles, peeled sweet potatoes that melt in one sip, and minced chicken breast meat. I have seen many patients start to drift off at this stage and feel that they are better. I want to try barbecue and milk tea. The one that impressed me the most was a 26-year-old young man who had an appointment with a friend to have barbecue on the 12th day after the operation. He thought that it would be 15 days soon and it would be okay to eat two skewers of barbecued tendons. However, he was hospitalized in the emergency room for massive bleeding that night. He was about to be discharged, but he stayed for an extra week, so he really couldn't do it.

There are also a few questions that people often ask, let’s talk about them together: Can I drink milk? If you usually drink milk and you are prone to flatulence and diarrhea, then don't drink it during this period. Drinking milk when you are lactose intolerant will only increase the burden on your intestines. If you drink it normally, you can drink a small amount of warm food instead of ice. Can I eat fruit? To be on the safe side, just drink pure juice that has been filtered out of residue. If the healing process is good, you can also eat a small amount of steamed, peeled apple puree or kiwi fruit puree, not too much, just taste a few mouthfuls. Don’t touch anything spicy, hot, fried, shelled, or seeded (such as kiwi seeds and dragon fruit seeds). These things will either irritate the intestinal mucosa or easily scratch the wound, and they are useless.

Don’t take any chances that “just one bite will be fine”.

In fact, to put it bluntly, there are really not so many fancy rules for the 15-day diet. The core is to treat yourself like a toothless old lady. Cook everything until it is soft and melts when you take a sip. It doesn’t matter if it is cold, but not hot. It doesn’t matter if it tastes bland. Don’t be salty or spicy. Everyone's wound size and healing speed are different. You may not be able to eat what others can eat, and you may be able to take a few bites of what others can't eat. If you are really unsure, just take a photo and ask the doctor. It's better than running to the outpatient clinic after eating and having an accident, right?

If you experience obvious abdominal pain, bloating, or dark red or bright red bloody stools after eating, don’t carry it and go to the hospital quickly. This is the bottom line.