Ideally, treatment already begins before surgery by compensating any existing malnutrition or nutritional definiencies by tube feeding or nutritional drinks. The diet therapy approach applied after surgery again depends on:
Length of the small intestine remaining
Adaptability of the remaining intestine
Whether or not the ileum or the jejunum were removed
Whether or not the ileocecal valve was removed
In addition, possible partial or total colectomy
Immediately tailored to the patient?s needs:
Generally, oral food intake should be initiated immediately after the operation in order to make maximum use of the remaining absorption capacity and to stimulate the adjustment of the remaining intestine.
Adaptation is possible up to a 50% removal of the small intestine (villi training).
After the removal of the jejunum, the absorption of nutrients is usually taken over well by the ileum.
If the level of adjustment is not sufficient or the length of the remaining bowel is insufficient, nutrient supply (especially water, minerals, trace elements) must be combined with parenteral nutrition.
Was the small intestine removed while the colon is still intact? Hardly any diarrhea with intact terminal ileum (because of bile acid reabsorption). An intact colon ferments unused carbohydrates into short-chain fatty acids (with the help of bacteria) and absorbes them ( energy supplier! + fosters Na and water reabsorption in the colon reduction of diarrhea).
If the remaining bowel length is 50-70cm, exclusive oral food intake is still possible, however a special training is required.The villi trainining conducted by us may take up to 12 months and is not always 100% successful. However, an improvement of the symptoms is usually achieved. Adjuvant parenteral nutrition is necessary and can be initiated by our hospital or comparable outpatient departments. Patients must be strictly guided by the hospital and their general practitioner (blood samples need to be taken regularly).
If the ileum is not intact or has been resected, bile acid and salts are transferred into the colon. These inhibit water reabsorption in the colon and thus lead to colonic diarrhea. In addition, if more than 100 cm of the ileum were removed, steatorrhea may occur quite frequently.
Small bowel resection with colectomy; water and electrolyte resorption are eliminated. It is difficult to stabilize the balance. Diarrhea hardly treatable.
If the remaining bowel length is 110-115cm, exclusive oral food intake is still possible. However, villi training and adjuvant parenteral nutrition are often temporarily required.
Colectomy + resection of the ileocecal valve: Further major water and electrolyte loss and severe diarrhea.
If the remaining bowel length is 30-50 cm, then parenteral nutrition must be applied on a long-term basis. Patients should be referred to a medical center for long-term nutritional support (see specialist clinics).