Preparing for hernia surgery involves several steps to ensure the best possible outcome. Dietary modifications play a crucial role, particularly in the weeks and days leading up to the procedure. This article provides a detailed overview of dietary recommendations before hernia surgery, incorporating insights from medical studies and expert advice.
Understanding the Need for Dietary Changes
Dietary adjustments before hernia surgery aim to optimize the patient's condition, facilitating the surgical procedure and promoting a smoother recovery. For individuals undergoing laparoscopic anti-reflux surgery, a very low-calorie diet (VLCD) or low-calorie diet (LCD) is often recommended to improve access to the hiatus. Obesity is a significant risk factor for developing non-alcoholic fatty liver disease, which can complicate surgical procedures.
The Role of Low-Calorie Diets
Some surgeons advocate for VLCDs (450-800 kcal/day) or LCDs (800-1500 kcal/day) in the preoperative period to reduce liver size. A study examining liver volume after treatment with an Optifast® VLCD for six weeks using magnetic resonance imaging (MRI) revealed a 14.7% reduction in mean liver volume. The surgeons in this study reported that operability improved due to better visualization of the gastro-esophageal junction and easier liver retraction.
Optimal Duration for LCD
Research suggests that the optimal duration for an LCD to achieve maximal liver volume reduction is approximately three weeks or less. A study involving patients undergoing laparoscopic anti-reflux surgery found that 88% of participants achieved maximal liver volume loss within three weeks, with 47% reaching this milestone after just one week on an LCD. This indicates that prolonged preoperative LCDs may not provide additional benefits.
Assessing Liver Volume
Prior to surgery, estimating a patient’s liver volume can be attempted through clinical examination using the palpation method. However, studies have shown this technique to be inaccurate and potentially misleading. While computed tomography (CT) and MRI remain the gold standard for measuring liver volume, they are expensive, not readily accessible, and carry contraindications such as radiation exposure (CT) and claustrophobia (MRI). Ultrasound, on the other hand, is non-invasive, non-radiating, fast, and inexpensive.
Read also: Hiatal Hernia and Diet
Study on Liver Volume Reduction
A study aimed to determine the optimal amount of time on an LCD before laparoscopic anti-reflux surgery to achieve maximal liver volume reduction. The study also assessed the accuracy of bedside ultrasonography against MRI. Participants scheduled for laparoscopic anti-reflux surgery were recruited between 2018 and 2021. The inclusion criteria were: English-speaking, competent to give consent, over 18 years old, and a body mass index (BMI) of > 22 km/m2. Participants with prior liver resection or those unable to undergo MRI were excluded.
LCD Protocol
Each patient was assessed by an experienced dietitian to determine the optimal time on a preoperative LCD. Body composition analysis was performed using the InBody® 230, liver ultrasound, and liver MRI. Participants were instructed to consume three VLCD products per day (Optifast® VLCD, Optislim® VLCD, or Proslim Rapid VLCD), a minimum of two liters of low energy fluids, a minimum of two to three cups of low starch vegetables, and one teaspoon of oil.
For participants with lower-than-normal predicted skeletal muscle mass, an additional entrée meal and, in some cases, an additional snack were included to optimize compliance and prevent muscle mass wasting. The additional entrée meal generally consisted of 50-200 g of raw weight lean protein (e.g., lean red meat, chicken breast, fish, or eggs) and, in individual cases, 20-40 g of carbohydrate. The dietitian adjusted the LCD if a participant’s weight loss consistently fell below 1 kg per week, either by eliminating the additional prescribed protein or carbohydrate. Participants were encouraged to include strength and resistance training and/or walking in their daily routine to prevent muscle mass wasting.
Results of the Study
The study found that 47% of participants lost most of their liver volume after only one week on an LCD. Close to 90% of participants achieved maximal liver volume loss within the first three weeks of an LCD, suggesting that there is little value in enforcing a longer duration of a preoperative LCD. Participants in the study lost an average of 19% of their liver volume by following an LCD for a mean time of 3.9 weeks.
Accuracy of Measurement Methods
The study also found that bedside ultrasonography (using Child’s equation) was as accurate as MRI in measuring liver volume. Additionally, the InBody® 230 body composition analyzer was found to be very accurate in the indirect measurement of liver volume.
Read also: Understanding Hiatal Hernia Before Weight Loss
General Dietary Recommendations Before Hernia Surgery
Pre-Surgery Consultation
Before your abdominal incisional hernia surgery, it’s crucial to consult with your healthcare team. They will provide specific instructions based on your individual health needs and the type of surgery you are undergoing. Always inform your healthcare providers of all medicines and supplements you are taking, as some may need to be adjusted or stopped before surgery.
Clear Liquid Diet
Two days before hiatal hernia repair, start a clear liquid diet. The purpose of this diet is to help "shrink" the liver prior to surgery, which improves the exposure of your hiatal hernia during the operation.
Fasting
Keep your stomach empty: Don’t eat or drink anything (not even water) after midnight the night before surgery. Your surgery may be canceled if you eat or drink before surgery. The reason for this is to reduce the risk of aspiration during anesthesia.
What to Include in a Clear Liquid Diet
A clear liquid diet includes only liquids you can see through. Some options are:
- Water
- Clear broths
- Plain gelatin (such as Jell-O®)
- Clear fruit juices without pulp (such as apple juice, white grape juice, or cranberry juice)
- Popsicles without fruit pieces or creamy fillings
- Black coffee or plain tea (without milk or creamer, sugar is okay)
- Hard candy and gum
If you have diabetes, pay attention to the amount of sugar in your drinks. It will be easier to control your blood sugar levels if you include sugar-free, low-sugar, or no added sugar versions of these drinks.
Read also: Lifestyle Changes for Hiatal Hernia
What to Avoid
Avoid the following foods and beverages:
- Alcohol
- Whole milk
- Drinks containing milk or creamer
- Drinks with red or purple dye
- Solid foods
- Citrus fruits like limes and oranges
- Tomatoes and tomato-based foods, such as salsa, bruschetta, and spaghetti and pizza sauces
- Spicy foods
- Fried and fatty foods
- Sugary foods
- Foods high in sodium
- Chocolate
- Peppermint and mint
- Caffeinated teas
- Carbonated drinks, such as seltzer water and soda
Lifestyle Adjustments
Quit Smoking
Surgeons typically recommend that people who smoke stop smoking prior to hernia surgery to help prevent complications. Smokers are four times more likely to develop recurrent hernia after their hernia repair surgery and are also more likely to develop postoperative infections than non-smokers.
Medications
Talk to your doctor before surgery about all the medications (even vitamins) you’re taking. Some (like aspirin, blood thinners, or anti-inflammatory medications) may affect your surgery or recovery. Your doctor can advise whether or not you should stop taking them and if so, for how long.
Bathing
Shower or bathe with antibacterial soap the evening before or the morning of surgery. A 4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery.
Get Assistance
Recovery is a gradual process and healing takes time. Allow yourself time to heal after your hernia repair and let family and friends help you, especially the first few days post-surgery.
Arrange for Appropriate Time Off
Be sure to take the appropriate amount of time off work to allow yourself to recover from surgery. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own. Plan to have someone drive you home afterward.
Managing Hiatal Hernia Symptoms Through Diet
For those with hiatal hernias, dietary modifications can significantly impact acid reflux and other associated symptoms. Avoiding citrus fruits, fatty foods, and carbonated beverages may prevent irritation. Eating foods high in fiber, probiotics, and whole grains may also help.
Foods to Eat
Non or low-acidic foods will reduce the likelihood and severity of hiatal hernia symptoms. The best food choices for people with hiatal hernias are non-acidic, minimally processed, and contain dietary fiber.
Safe foods to eat may include:
- Leafy greens
- Beans and peas
- Whole grains
- Lean proteins, including tofu and fish
- Whole nuts and seeds
- Non-citrus fruits and juices
- Artichoke and asparagus
- Ginger
- Low-fat, non-sweetened dairy products
- Cardamom
- Coriander
- Apple cider vinegar
- Non-caffeinated teas, especially green teas
- Cinnamon
Fermented or cultured foods that are rich in probiotics (acid-neutralizing stomach bacteria) may also help reduce hiatal hernia symptoms. It is important to note that consuming processed sugar alongside probiotics may be counterproductive.
Tips for Reducing Acid Reflux
To reduce the chance of acid reflux, consider these tips:
- Cook with healthy fats, like avocado, coconut, and olive oils.
- Eat whole foods instead of processed foods whenever possible. The fiber content of fresh foods should help with your acid reflux.
- Eat small meals every few hours instead of three large meals during the day.
- Add probiotic foods to your diet. Cultured vegetables, like pickles, are a tasty option. Yogurt, kefir, and kombucha are other good choices. Taking a probiotic supplement is also an option.
- Drink plain water. Drinking 8 glasses of water per day may help. Try adding lemon to your water for additional acid-lowering power. Lemon is a fruit that, although acidic outside the body, is metabolized to have alkaline byproducts.
- Walking after eating and avoiding going to bed shortly after a meal
- Elevating the head of your bed so your chest is slightly higher than the legs
- Sleeping on your left side
- Managing your weight so it’s optimal for your age and height
- Stopping tobacco use if you smoke
- Skipping tight-fitting clothes, which can make your heartburn worse
- Asking a healthcare professional about over-the-counter (OTC) medications that may reduce acid in your stomach
- Taking probiotics and digestive enzymes
- Eating your meals in a calm and relaxing place
- Eating slowly and chewing well
- Avoiding standing up while eating
What to Expect After Surgery
Immediate Post-Operative Care
For the first 24 hours after surgery, you may not have much of an appetite or feel like eating heavy foods. It is recommended to keep up with your liquids. As your appetite increases, you will find yourself eating normally.
Pain Management
You will be given a prescription for pain medication. Take this as directed for post-operative pain. If you are experiencing only mild discomfort, you may find over-the-counter medications, such as Tylenol (acetaminophen) or Advil/Nuprin (Ibuprofen), may be all you need for comfort.
Managing Constipation
If constipation becomes a problem, an over-the-counter stool softener (Metamucil) or a mild laxative (Milk of Magnesia) may be taken.
Activity and Movement
There are no restrictions on daily activities, including going up and down stairs. It is encouraged to walk frequently, and there are no restrictions on the distances you may walk. You are restricted only by your level of comfort.
Bowel Movements
The first bowel movement may occur anywhere from 1-10 days after surgery. As long as you are not nauseated or having abdominal pain, this variation is acceptable.
Wound Care
You may notice a slight drainage (usually pink or reddish in color), bruising, or slight swelling around the incision. This is normal and not cause for concern. Likewise, it is normal to have a lump or hardness under or near the incision. You may also have bruising and some swelling of the genitalia, which is not uncommon.
Follow-Up Appointments
You will be seen in your doctor's office within 2 weeks and again in 6 weeks after the surgery. Prior to surgery, you should have made an appointment for your first post-operative visit.
Diet Modification Following Hiatal Hernia Repair
After surgery, you will be admitted for 23-hour observation and pain control. You will be discharged home within 23 hours on a full liquid diet. You will stay on a full liquid diet for two weeks, after which your doctor will advance you to a soft diet for an additional two weeks. You should return to a regular diet four weeks after surgery. This diet modification is important because swelling at the gastroesophageal junction is normal after surgery, and you may find that solid foods “get stuck.” This is expected during the first four weeks, which is why gradual dietary progression is recommended as the swelling subsides.
Long-Term Lifestyle Changes Following Hiatal Hernia Repair
This procedure is designed to be an anti-reflux surgery, and most patients will be unable to belch to relieve gastric air after the operation.