Management of postgastrectomy syndromes

Article Abstract:

Postgastrectomy syndromes are a group of disorders that result from operations on the stomach that disrupt normal stomach function and change the physiology of the stomach and intestines. These disorders can be either of mechanical or physiological origin. Postgastrectomy syndrome may result from the inability of the pyloric sphincter (muscular ring separating the stomach and the intestine) to function properly as a sphincter or as a result of vagotomy (cutting of branches of the gastric nerve in order to reduce the amount of gastric acid secreted). Alkaline reflux gastritis, or vomiting bile, is the most common form of postgastrectomy syndrome. Diagnosis requires a complete gastrointestinal evaluation with gastroscopy (endoscopic examination of the stomach), including biopsy of the stomach. Medical treatment is often tried first, but usually surgical intervention is necessary. Roux stasis, a condition in which the stomach contents are not properly moved though to the intestine, is characterized by an early sense of fullness when eating, pain after eating, nausea and vomiting and delayed stomach emptying. Gastroscopy may correct the problem by dilating the obstructed portion. Persistent roux stasis may require a near total gastrectomy (removal of the stomach). Afferent loop syndrome occurs early in the postoperative period and its onset is abrupt, with epigastric pain, rapid heart beat, fever, nausea and vomiting and usually abdominal tenderness. Urgent operation is needed. Postvagotomy diarrhea, if severe, may result in fecal incontinence, weight loss and malnutrition. Most patients respond to medical treatment. Dumping syndrome, the rapid passage of food and fluid into the intestine, results from loss of part or all of the stomach as a reservoir. Most patients are successfully treated with changes in diet, and less than 2 percent of patients may have severe symptoms and need surgery. Late dumping syndrome is caused by an insulin response and is relieved by eating carbohydrates. It is felt that most patients with postgastrectomy syndrome can be treated conservatively, but if the cause is mechanical, surgery may be useful. (Consumer Summary produced by Reliance Medical Information, Inc.)

Stomach

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The Roux operation for postgastrectomy syndromes

Article Abstract:

Any stomach operation disturbs the motor function and regulation of the stomach. Disturbances in stomach motor function cause pain, nausea, vomiting and diarrhea and occur in about 25 percent of patients following gastric operation. When symptoms are severe additional surgery is usually necessary, most often a Roux-Y gastrojejunostomy. This procedure is performed for alkaline reflux gastritis (stomach inflammation caused by excess acid) because it eliminates the reflux of bile and pancreatic juice back into the stomach. This procedure can also be used in patients with dumping syndrome, in order to slow stomach emptying. Dumping syndrome (profuse sweating, nausea, dizziness and weakness) occurs in postgastrectomy patients and is caused by too swift emptying of the stomach contents into the duodenum. Patients who have delayed stomach emptying can be helped by a Roux operation combined with an almost total removal of the stomach. This removes the inert portion of the stomach, which speeds emptying and prevents reflux of stomach acid into the esophagus. Following the Roux operation a syndrome known as the Roux stasis syndrome can develop; it is reported to occur in from 10 to 50 percent of Roux patients. This consists of abdominal pain, sensation of fullness in the upper abdomen, nausea and vomiting of food. Roux stasis syndrome is most often treated surgically. The incidence of postgastrectomy syndrome is likely to decrease with the recent marked decrease in gastric surgery. When stomach surgery is needed, there are procedures that have a low incidence of postgastrectomy syndrome. These involve selective cutting of branches of the vagus nerve, to reduce the amount of gastric acid secreted, with preservation of innervation and function of the pylorus to avoid the problems of stomach drainage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Jejunum

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Proximal gastric vagotomy in the emergency treatment of bleeding duodenal ulcer

Article Abstract:

Peptic ulcer may be treated by vagotomy (cutting of branches of the vagus nerve to reduce the secretion of gastric acid). Truncal vagotomy and antrectomy (removal of the antrum of the stomach) cause a high incidence of serious postgastrectomy symptoms. About 20 years ago, a new procedure, proximal gastric vagotomy without drainage, was introduced. Because the proximal vagotomy has not been widely used to treat duodenal ulcers, retrospective study was undertaken to determine the complications and long-term results of this technique in patients with this type of ulcer. Between January 1973 and June 1986, 200 patients underwent emergency surgery for bleeding duodenal ulcer; 52 patients had a proximal gastric vagotomy performed. There were no deaths or reoperations in the postoperative period. Six patients had complications, including one patient with rebleeding of the ulcer, and two patients with prolonged absence of stomach motility. At an average follow-up of 2.9 years, 48 patients were alive, and four had died from non-ulcer related causes. Duodenal ulcer recurred in six patients (12 percent); three required surgery. It is concluded that proximal gastric vagotomy is safe and effective for treating bleeding duodenal ulcer. However, since it is a long operation (average length is 3 hours and 20 minutes), this technique should be limited to low-risk, hemodynamically stable patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gastrointestinal bleeding, Gastrointestinal hemorrhage, Duodenal ulcer

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