Postgastrectomy syndromes

Abstract

Postgastrectomy syndromes requiring further operation are fortunately uncommon, as the symptoms are disabling and the results of corrective surgery are, at times, disappointing. Our sixty-six patients underwent a total of seventy-six procedures with forty-one successful results and thirty-five failures. Among the secessful group, only fourteen results were graded as excellent. (Table V.) Our experience, like that of others, demonstrates the necessity of accurate evaluation of the patient and of accurate syndrome classification. This not only allows the appropriate operation to be chosen but also helps to indicate those in whom operation should be avoided. Where more than one surgically remediable syndrome exists, simultaneous correction should be undertaken. Treatment of the mechanical problems of obstructed afferent loop by jejunojejunostomy and of stomal obstruction by complete stomal reconstruction provides satisfactory results. Roux-en-Y anastomosis is effective in patients with alkaline gastritis, but we caution against the use of this procedure in patients with vague symptoms and minimal endoscopic changes. Antiperistaltic jejunal reversal is the procedure of choice in managing severe postvagotomy diarrhea. Although most patients with dumping can be managed conservatively, a small number with severe symptoms and nutritional problems cannot and require further operation. Our experience with conversion from Billroth II to Billroth I and with isoperistaltic interposition, although minimal, has been reasonably satisfactory. Four groups of patients remain with symptoms of chronic vomiting, late postvagotomy atonic stomach, dumping "plus," and miscellaneous symptoms. These patients have complaints that are difficult to define and usually have poor results with further operations. We believe that surgery should be avoided in these patients and that conservative measures be continued.

Roux diversion for bile reflux following gastric surgery

“…IN an appreciable number of patients the results of operations for the cure of peptic ulcer are marred by reflux of bile into the stomach, setting up a gastritis easily recognizable at endoscopy (Brooke-Cowden et al, 1976) with characteristic histological changes in the mucosa (Drapanas and Bethea, 1974). This causes severe burning or boring epigastric pain in the great majority of patients and is usually associated with vomiting of bile.…”

Altered Contractile Responsiveness in Ileal Longitudinal Muscle After Total Gastrectomy in a Rat Model

“…1,2 Loss of body weight is an important characteristic of postgastrectomy syndromes; 3,4 however, the exact reasons for weight loss after total gastrectomy are still unclear. Acceleration of small intestinal transit, supposedly resulting in a decreased contact time of chyme with the small intestinal mucosa, has been blamed, but others have found that small intestinal transit is slowed after total gastrectomy.…”

Reflux Gastritis Syndrome

“…Anemia usually is due to iron deficiency and is noted in over half of the patients following gastric surgery [49], The occurrence of a symptom complex suggestive of bile reflux in a patient with a history of gastric surgery in the past raises other possibilities, such as recurrent peptic ulcer disease, gastric outlet obstruction, and afferent loop obstruction. 'Dumping-plus' is a variant of this syndrome which refers to the coexistence of the early dumping syn drome and bilious vomiting in the same pa tient [50]. Hypochlorhydria [47] is a com mon finding.…”