Grains and Bakery Products:

Allowed: White bread (day-old or toasted), white flour pasta, husked white rice, semolina, plain cornflakes, plain white flour biscuits (e.g., plain digestive biscuits).

Avoid: Wholemeal/rye/seed/bran bread, wholemeal pastries, brown/wild rice, wholemeal pasta, high-fiber whole grains (e.g., whole oat flakes), popcorn.

Vegetables:

Allowed: Potatoes (peeled, boiled/baked/pureed), carrots (peeled, well-cooked, mashed), zucchini (peeled/deseeded, boiled/baked), strained tomato juice, baked/boiled tomatoes (peeled/deseeded, in moderate amounts). Young green beans (very well cooked, small amounts, only if specifically permitted by the doctor and cause no discomfort).

Avoid: All raw vegetables, vegetables with unremoved skin/seeds, broccoli, cabbage (all types), cauliflower, raw/cooked celery (if fibrous), garlic, onion, leeks (especially raw or in large quantities), peppers (especially raw or with skin), cucumbers, mushrooms, corn kernels, peas, lentils, dried beans.

Fruits:

Allowed: Ripe bananas, apples (peeled, boiled/baked, pureed), pears (peeled, boiled/baked, pureed), canned fruits (peeled/pitted, e.g., peaches, apricots), clear, strained fruit juices (without pulp/added sugar, e.g., clear apple juice).

Avoid: Raw fruits with skin/seeds (e.g., strawberries, raspberries, kiwi), dried fruits (prunes, raisins, dates), nuts, hazelnuts, seeds (flax, chia, sesame, etc.), coconut, fresh pineapple, whole citrus fruits (strained lemon juice may be allowed in small amounts), fresh plums/prune juice.

Meat, Fish, Eggs:

Allowed: Lean beef/poultry (chicken, turkey, skinless/visible fat removed, boiled/baked/grilled/stewed), lean fish (cod, pike-perch, trout, hake - boiled/baked/steamed), soft-boiled eggs (soft yolk), diet omelet (from whole eggs or whites only, prepared with minimal fat).

Avoid: Fatty meat (fatty pork, lamb), processed meat (cold cuts, sausages, hot dogs, salami, parizer), canned fish in oil/tomato sauce, roe, hard-boiled eggs, fried or heavily spiced meat.

Dairy:

Allowed: Sweet milk (skimmed/partially skimmed, if tolerated and does not cause bloating), fresh lean cottage cheese, fresh whey cheese, fresh unsalted/unfermented cheese. Lean sour cream (10-12% fat) and butter in small quantities (e.g., 5g per meal), if tolerated.

Avoid: Buttermilk, sana, kefir, yogurt (especially those with fruit or whole grains, as per doctor's instructions), fermented, aged, moldy cheeses, fatty sour cream.

Fats and Oils:

Allowed: Butter (small quantities), spreadable margarine (in moderation), vegetable oils (olive, sunflower) used in moderation for cooking (not frying).

Avoid: Mayonnaise, fried foods, excessive animal fats (lard, bacon), fatty commercial sauces.

Beverages:

Allowed: Still water (minimum 1.5-2L/day), non-irritating herbal teas (chamomile, linden, St. John's wort – unsweetened or very lightly sweetened with honey if allowed), clear strained fruit juices (apple, white grape – without added sugar).

Avoid: Coffee, black/green tea (if prohibited by doctor), hot chocolate/cocoa, pulpy juices, nectars, carbonated drinks, alcohol in any form.

Condiments and Sweets:

Allowed: Salt (moderately), mild dried or fresh aromatic herbs (dill, parsley, lovage, thyme – if tolerated, in small amounts), vanilla, cinnamon (very little). Honey, sugar (in great moderation), plain jellies (from clear juice), fine jams/preserves (without seeds/skins, with low sugar content, e.g., from apples, pears), homemade semolina/rice puddings with skimmed milk, tarts with white dough and permitted fruit filling (e.g., grated cooked apples).

Avoid: Pepper (black, white, red), hot paprika, mustard, horseradish, pickles, excessive vinegar, hot/exotic spices. Concentrated commercial sweets, cakes with fatty creams, puff pastry products, chocolate (as per doctor's instructions).

The ERAS (Enhanced Recovery After Surgery) protocol aims to accelerate post-operative recovery. An important component is pre-operative carbohydrate loading, which helps reduce metabolic stress induced by surgery and improve glycemic control.

Recommendations (MUST discuss with the anesthesiologist/surgeon before proceeding):

• Evening before surgery (e.g., 8:00-10:00 PM): Consumption of a carbohydrate-rich drink, providing approximately 80-100g of carbohydrates (e.g., 800-950ml of clear, unsweetened apple juice, or special pre-operative drinks if indicated by the doctor).
• Morning of surgery, 2-3 hours before anesthesia induction (NO later): Consumption of a drink providing approximately 40-50g of carbohydrates (e.g., 400-475ml of clear apple juice or special drink).

Juices must be clear, without pulp, to avoid leaving residues in the stomach. Avoid citrus juices or those with high acidity. It is essential that these liquids be consumed up to the time limit indicated by the medical team (usually 2 hours for clear liquids before anesthesia).

Contraindications and Precautions: This protocol is not suitable for all patients. Contraindications may include poorly controlled diabetes mellitus (especially type 1 or insulin-dependent type 2), severe gastroparesis (delayed gastric emptying), severe gastroesophageal reflux, previous gastric surgeries affecting stomach emptying, massive ascites, dysphagia (difficulty swallowing). The doctor will assess the eligibility of the individual concerned.

Week 1 (Days 1-7 post-operative):

Days 1-2 (according to strict medical indications): Clear liquid diet (still water, unsweetened chamomile tea, very weak vegetable/chicken broth, only strained liquid, plain unsweetened gelatin). Small, fractional quantities (e.g., 50-100ml every 1-2 hours).

Days 3-7 (progressively, depending on tolerance and return of bowel function): Full liquid diet. May add: skimmed/lactose-free milk, plain, skimmed natural yogurt (if permitted and tolerated), fine, very well-strained cream soups, from allowed vegetables (carrot, zucchini, potato – peeled/deseeded). Towards the end of the week, if tolerance is good, semi-solid/soft foods may be introduced: fine purees of allowed vegetables, very well-cooked and finely mashed chicken/white fish, soft-boiled egg (yolk only initially, then white if tolerated), fresh, lean, mashed cottage cheese. Strained tomato juice or very fine tomato cream soup (without skin/seeds) in very small quantities for testing, if permitted by the doctor.

Week 2 (Days 8-14 post-operative):

Continue soft diet, slightly more consistent textures, but very low fiber and fat content. May introduce: toasted white bread (initially without crust, then with crust if tolerated), plain white flour biscuits. Allowed fruits (ripe bananas, boiled/baked and mashed apples/pears, peeled) in small portions. Protein intake should be gradually increased through lean boiled/baked and finely minced meat, lean fish, eggs, permitted dairy. Cooked tomatoes (fine sauce, strained, added to pasta/rice) may be tried in small amounts.

Gradual Reintroduction of Dietary Fiber (with caution, as advised by the doctor):

This is a crucial stage and must be done slowly, carefully monitoring tolerance. Start with small amounts of soluble fiber, which are gentler on the digestive system.

Each new food is introduced individually, in small quantities, every 2-3 days, to identify any intolerances (bloating, cramps, diarrhea). Increase fluid intake as fiber intake increases.

Bloating and Gas: Chew food slowly and completely. Avoid carbonated drinks and straw use. Introduce new foods, especially high-fiber ones, gradually and in small amounts. Certain teas (mint, fennel, ginger – if tolerated) may help.

Constipation: Ensure adequate hydration (minimum 2 liters of water/day). Gradually increase fiber intake from fruits, vegetables, and whole grains, according to tolerance. Regular light exercise (walking) stimulates bowel movements. Do not use laxatives without medical advice.

Diarrhea: If it occurs, rehydrate with water, unsweetened herbal teas, clear soups, oral rehydration solutions (if severe). Temporarily revert to more astringent and low-fiber foods (cooked white rice, ripe bananas, baked/boiled apples, toasted white bread, boiled chicken). Avoid milk (except for plain natural yogurt, if tolerated), fatty foods, fried foods, concentrated sweets, hot spices. Inform your doctor if diarrhea is severe, persistent, or accompanied by fever/blood in the stool.

Immediately Post-operative (with medical approval): Gradual resumption of movement is encouraged (e.g., light walking in the ward/at home). It helps prevent complications (thrombosis, pneumonia) and stimulates the resumption of intestinal transit.

Long-term (after complete healing and with doctor's consent): Regular physical activity is extremely beneficial. It contributes to maintaining a healthy weight, improves mood, muscle tone, and can reduce the risk of cancer recurrence and the onset of other chronic diseases. A minimum of 150-300 minutes of moderate-intensity physical activity (brisk walking, swimming, light cycling) or 75-150 minutes of vigorous-intensity physical activity per week is recommended, plus strength exercises twice a week.

Monitoring body weight (e.g., weekly weighing, under the same conditions) is important to promptly identify unintended weight loss or excessive gains. Appetite fluctuations are normal during recovery; however, persistent inappetence, difficulty swallowing, or early satiety leading to insufficient food intake and weight loss require medical and dietary evaluation. A food diary can be useful for tracking intake and tolerance.