An innovative transoral stomach stapling in Poland – dietician’s key tasks

It was the first time a stomach stapling surgery had been performed with a transoral method, that is without opening abdominal cavity. A dietary advice and care for patients in this respect is given by Anna Maria Borucka, a Rehasport Clinic dietician.

Three surgeries in Franciszek Raszeja City Hospital in Poznań were performed by PhD Gontrad Lopez-Nava and PhD Aleksander Sowier. The Spaniard is an outstanding specialist in this field of medicine, that is endoluminal stomach stapling. However, a pioneer of this method in Poland is PhD Aleksander Sowier, a head of Department of General, Little-Invasive and Trauma Surgery in Franciszek Raszeja City Hospital in Poznań. Stomachs of three patients were stitched from the inside with the use of a special head which was carried through mouth. So far stomach stapling surgeries in Poland have been performed solely with a transdermal method which however entailed increased risk of complications and longer recovery time. With regard to endoscopic method, special stitches are drawn, stomach lining remains intact, while the entire stomach remains inside. Motor functions of this organ are therefore maintained. A stomach fundus, where usually food lies, remains in the same place, and thanks to this a feeling of satiety is faster. A dietary consultant during these surgeries was Anna Maria Borucka, a Rehasport Clinic dietician and doctoral student in the Department of Biochemistry at Poznań University of Physical Education.

– Everyone’s stomach has a specific capacity, but patients who underwent a surgery had much larger stomachs. As a result of such surgery, the stomach capacity reduces by up to 70%. Let’s assume that a patient weighs 160kg, so the body weight grew longer, which must have entailed a high-calorie diet. Now his stomach is tiny. What to do then to make sure the patient eats, slims down and does not experience any side effects? It is necessary to use a suitable amount of micro- and macro-nutrients in order to secure him or her for the purpose of protein supply which is one of the most important nutrients – says Anna Maria Borucka. A dietician is not only involved in the surgery but must also provide assistance in the post-surgical period (a few weeks afterwards). – If we consider the change of diet itself, a cooperation with a dietician in the space of these two months is crucial. First two weeks involve a liquid diet, then pulpy diet, and solid products are gradually introduced afterwards. Cooperation after the bariatric surgery lasts a way longer, that is one or two or even three years. Then I take care of my patients. If an earlier bariatric surgery is required, a vast majority of patients regain their initial weight after two or three years. The key is to keep them with this low weight which can be gained after a dozen months – says Rehasport Clinic dietician.

The most difficult dietician’s duties come on first days after the surgery. The patient cannot be given solid food, e.g. chicken breast piece, because it is too large. Nutrition starts then from a liquid diet which lasts for about two weeks. Another two weeks are dedicated to a pulpy diet with a selection of vegetables and fruits. – We also introduced dairy products and during further weeks more and more solid products were included. I must supervise patients on a continuous basis, tell them how much food they are supposed to have, make sure they defecate properly. There is a multinational procedure but in Poland has not been used so far. I had to act on the basis of my experience and react to patients’ remarks. If something is wrong, we modify their diet. I keep in touch with patients on a regular basis – says Anna Maria Borucka.

According to Rehasport Clinic dietician, the new method of stomach stapling, used in Poznań by PhD Gontrad Lopez-Nava and PhD Aleksander Sowier, is likely to be widely used in the future. – Particularly when we consider patient’s comfort because our patients felt very good after two days. The same happened two, three weeks later. They still have to be careful because they satiate quickly. At first when liquids accumulate in their stomachs, they do not feel thirsty. This is why they set alarm clocks to make sure they drink e.g. 100 or 150 milliliters of water within an hour. They eat every 2,5 hours but food is limited, 40 milliliters each. The main factor which limits food consumption is a feeling of satiety. If a patient keeps a teaspoon in the oral cavity but feels satiated, he or she stops eating. The patient must stop – says Rehasport Clinic dietician.