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Nutrition
Optimized nutrition is one of the most important factors in successful healing after any type of surgery. There is a lot of conflicting information about nutrition on the internet, and everyone is bound to have a strong opinion. When it comes to your surgery, I would recommend focusing on 3 things.
- Diet – recommend a balanced diet – avoiding ultra-processed foods. I favor natural foods with reasonable caloric intake.
- A good rule of thumb is to shop on the outer edge of the grocery store – vegetables, fruits, meats, fish, fresh carbohydrates, cheeses, yogurt, etc.
- Weight – There are few universal consensus opinions in the field of nutrition, but maintaining a healthy weight with appropriate amounts of calories-in and calories-out is one of these universally accepted ideas. Body Mass Index (BMI) is an imperfect index, but a “healthy” range is defined as 18.5-25.
- BMI > 25 = it would likely benefit you to lose weight prior to surgery if possible, especially if >30.
- BMI < 18.5 = would potentially be considered malnourished. Recommend increasing caloric and protein intake before surgery if possible.
- If your surgery is elective, and you have the ability to adjust your nutrition either by increasing caloric intake or considering either medial or surgical (bariatric surgery) weight loss options, then I would strongly consider this before undergoing surgery.
- Essential Nutrients
- Protein
- Vitamins
Exercise
Exercise may be the single most important intervention that doesn’t get enough attention. It may be the most effective medicine in human history. It effectively treats essentially every chronic heart and lung disorder.
It is also EXTREMELY important to be in good shape prior to surgery. Keep in mind, this may look different for everyone. A professional athlete defines being in “good shape” differently than a 70 year old patient preparing for cancer surgery. At the minimum, I recommend exerting yourself at least 3-4 times per day. On average, this includes taking walks every day and ideally includes some type of resistance exercise.
I am hoping to recommend exercise regimens before surgery eventually. This is an area that I’m hoping to fill in the future. There are no universally accepted guidelines regarding this. Just like nutrition, it is somewhat of a black box.
Smoking
Cigarette smoking (and unfortunately vaping) is one of the leading direct causes of death in the United States.
Smoking increases the risk of surgery across the board including poor wound healing, increased lung complications, and even increased risk of death.
I strongly recommend stopping smoking in general for your health, but at least around the time of surgery. This will greatly reduce the chances of you having major problems after surgery.
Alcohol
Heavy alcohol use can increase surgical risks, increas the risk of experiencing withdrawal side effects, and potentially alter the effects of post-operative medications.
In liver surgery, this is particularly important as alcohol is directly toxic to the liver. If you drink more than 2-3 drinks per day, I highly recommend cutting back significantly before undergoing any sort of major surgery.
Medications
Make sure you share a complete list of your medications with your surgeon.
Especially important categories:
- Blood thinners
- Steroids
- Diabetic medications
- Heart medications (high blood pressure, water pills, beta blockers, medications for arrhythmias)
- Injectable weight loss medications
Be honest about supplements, herbs, or over-the-counter meds—many patients don’t mention them, but they can potentially affect anesthesia or bleeding risk.
Preparing Mentally
- Anxiety is normal: Surgery is overwhelming for many. This is routine for us, but not routine for any patient.
- Make sure your surgeon knows your goals:
What matters most to you?—lifespan? healthspan? independence? symptom relief?
Be as detailed as possible as this helps align surgical treatment with your values.
Bowel Preparation
Bowel preparation helps to prevent infection and decrease rates of leak after specific types of GI surgery. If you have been scheduled for surgery with Dr. Stokes, please click here to review his pre-operative bowel preparation instructions.
The rationale for bowel preparation is to clean out the colon prior to taking out a segment and reconnecting the two ends. This can be done in two ways:
- Mechanical – this is the “fun” part of the preparation which typically involves drinking an osmotic laxative (e.g. Miralax) in larger volumes in order to mechanically clear out all the stool in the colon. Typically this is combined with a fluid like Gatorade. This may be combined with other types of laxatives as well.
- Antibiotic – Antibiotics are often prescribed the night before surgery to decrease the burden of microbiota that would otherwise result in a breakdown of the bowel connection. The micro-environment inside the bowel is very complex and includes all sorts of bacteria. This is something that modern medicine is still trying to fully describe.
There is some controversy on what types of bowel preparations are most successful in preventing complications and preparing a patient for surgery. I would recommend following your surgeon’s recommendations.
What to expect in the operating room
Open Surgery
Laparoscopic Surgery
Robotic Surgery
- Preparing for Surgery
- Bowel preparation instructions
- Laparoscopic Surgery
- Robotic Surgery
- Anesthesia
- After Surgery
- Pain Control
- Activity Restrictions
- Wound Care
- Returning to Work and Driving
- How to Manage Surgical Drains
- How to Manage Feeding Tubes
- Surgical Complications