Why is there such a difference in post op diet?

Question

I just had vsg and my surgeon said to be on clear liquids for two weeks then full liquids for two weeks. And so on. I feel this is so excessive . I see other surgeons who allow puréed food 5 days post op. Why is there such a difference in the post op diet? Is there a medical reasoning for this? If I eat puréed food sooner will I damage my stomach? Is this serious? Thank you. Just having a hard time

Reza Keshavarzi, MD, FACS, FASMBS · Answer

Hi Clementine,
Thank you for your thoughtful question &mdash; and congratulations on taking such an important step toward your health with your recent vertical sleeve gastrectomy (VSG)!
You’re right that post-operative diet plans can vary a lot from surgeon to surgeon. The reason for the difference is that not all programs are built the same &mdash; and not all surgeons have the same training, experience, or philosophy when it comes to patient care and recovery.
In my practice, I’ve spent years developing a very specific and carefully designed diet protocol for my patients, based on my advanced fellowship training in bariatric surgery, my background in culinary arts and nutrition during my undergraduate years, and my hands-on experience caring for thousands of patients. My approach is both cautious and progressive because I want to give my patients the safest healing process and set them up for long-term success &mdash; not just short-term recovery.
I can’t speak for what other doctors do, but I base everything I recommend on the best available medical evidence, my surgical training, and my real-world experience seeing what helps patients truly thrive after surgery. My patients consistently do very well because the plan is structured, clear, and tailored for true healing.
As for your concern: eating puréed foods too early could potentially stress the newly healing stomach, which is still swollen and sensitive after surgery. That’s why some programs &mdash; like mine &mdash; are more conservative early on, focusing on clear liquids and then slowly advancing to full liquids and eventually purées. Giving the stomach the proper time to heal lowers the risk of complications like leaks, strictures, or prolonged inflammation.
I know this phase can feel frustrating, but it’s temporary &mdash; and protecting your healing now sets you up for amazing long-term results.
Hang in there &mdash; you're doing great, and asking these questions shows you are taking your recovery seriously!
Wishing you strength and a smooth journey ahead,Dr. Keshavarzi

Ali Solmaz, MD · Answer

After a vertical sleeve gastrectomy (VSG), the post-operative diet is designed to promote healing, minimize complications, and allow your stomach to adjust to its new size and function. Surgeons often recommend different timelines for advancing from liquids to pureed foods or solids because there isn’t a single standard protocol. These differences arise from variations in surgical training, personal experience, and patient care philosophies.
The primary reason for a gradual transition from clear liquids to full liquids, then to pureed foods, is to protect the staple line. After VSG, your stomach is stapled and reduced significantly, and the staple line needs time to heal securely. Introducing thicker or more textured foods too soon can increase pressure on the staple line, potentially causing complications like leaks, which are serious and require immediate medical attention.
Another reason for the slow diet progression is to reduce the risk of nausea, vomiting, or food getting stuck. The stomach is swollen after surgery, and its capacity is much smaller than before. Liquids are easier for the stomach to handle initially, minimizing strain and discomfort during the critical healing phase.
Some surgeons, based on newer evidence, feel that advancing to pureed foods as early as 5 to 7 days post-op may not significantly increase risks if patients follow strict portion guidelines and chew food thoroughly. However, this approach might not work for everyone. Healing rates can vary, and what’s safe for one person may not be for another.
If you eat pureed foods earlier than your surgeon recommends, you risk complications like staple line leaks, pain, or irritation to the healing stomach tissue. These complications can be severe, delaying your recovery and potentially requiring further medical intervention.
It’s essential to follow your surgeon’s recommendations because they are familiar with your specific surgery and medical history. If the liquid phase feels too restrictive or you’re struggling, consider speaking with your surgeon or a dietitian. They may adjust your plan or provide strategies to make the process more manageable.

Gopal Grandhige, MD · Answer

The differences in post-operative diets after vertical sleeve gastrectomy (VSG) can stem from various factors, including surgical technique, patient needs, and the surgeon's experience and philosophy. Some surgeons may adopt a more conservative approach, emphasizing clear liquids for a longer period to ensure healing and minimize complications, while others might allow puréed foods earlier for patient comfort and nutrition.
Medical reasoning for these diets often centers around promoting healing, preventing complications such as leaks or strictures, and ensuring the stomach adapts properly to its new size. Eating puréed food sooner than advised could potentially strain the healing stomach, leading to complications. It's essential to follow your surgeon's guidelines and discuss any concerns with them, as they are tailored to your specific situation. If you're struggling, consider reaching out for support to help navigate your recovery journey.

Pablo Garcia, MD · Answer

Hello!!
The reason is simple, each doctor and their nutritionist have a different protocol, there are some updates regarding the nutritional part that not all doctors apply because they have had better results as they always have.
I recommend that you go to your doctor and tell him about your concern.
I completely understand you, the process of adaptation and food re-education after bariatric surgery is not easy. Try not to compare your process, your diet with anyone else because you will see that as the months go by, many patients eat and do things that are very different from you, and it is not necessarily the right thing.

Hope my answer helped you!

Nicole Basa, MD, FACS · Answer

Every surgeon is different when it comes to how quickly they progress someone’s diet after bariatric surgery. As a bariatric surgeon I used to follow that time frame you are describing and then over time allowed the full liquid phase to start earlier. The main reason why the phases are set is to prevent leak before the stomach is fully healed. It takes approximately 6 weeks to be about 85% healed at the staple line where you are out of the woods from a leak. I know that if the diet is progressed too soon the patient is tempted to progress even faster to a regular diet which could result in obstruction of the stomach pouch and then leak. Think of this time as a sabbatical from food and a time to reflect on your relationship with food. You will have your whole life to eat regular food and will not be forced to stick to this liquid diet. Hope that helps!

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