Gastrectomy Health Article

Diagnosis/Preparation

Before undergoing gastrectomy, patients require a variety of such tests as x rays, computed tomography (CT) scans, ultrasonography, or endoscopic biopsies (microscopic examination of tissue) to confirm the diagnosis and localize the tumor or ulcer. Laparoscopy may be done to diagnose a malignancy or to determine the extent of a tumor that is already diagnosed. When a tumor is strongly suspected, laparoscopy is often performed immediately before the surgery to remove the tumor; this method avoids the need to anesthetize the patient twice and sometimes avoids the need for surgery altogether if the tumor found on laparoscopy is deemed inoperable.

Aftercare

After gastrectomy surgery, patients are taken to the recovery unit and vital signs are closely monitored by the nursing staff until the anesthesia wears off. Patients commonly feel pain from the incision, and pain medication is prescribed to provide relief, usually delivered intravenously. Upon waking from anesthesia, patients have an intravenous line, a urinary catheter, and a nasogastric tube in place. They cannot eat or drink immediately following surgery. In some cases, oxygen is delivered through a mask that fits over the mouth and nose. The nasogastric tube is attached to intermittent suction to keep the stomach empty. If the whole stomach has been removed, the tube goes directly to the small intestine and remains in place until bowel function returns, which can take two to three days and is monitored by listening with a stethoscope for bowel sounds. A bowel movement is also a sign of healing. When bowel sounds return, the patient can drink clear liquids. If the liquids are tolerated, the nasogastric tube is removed and the diet is gradually changed from liquids to soft foods, and then to more solid foods. Dietary adjustments may be necessary, as certain foods may now be difficult to digest. Overall, gastrectomy surgery usually requires a recuperation time of several weeks.

Risks

Surgery for peptic ulcer is effective, but it may result in a variety of postoperative complications. Following gastrectomy surgery, as many as 30% of patients have significant symptoms. An operation called highly selective vagotomy is now preferred for ulcer management, and is safer than gastrectomy.

After a gastrectomy, several abnormalities may develop that produce symptoms related to food intake. They happen largely because the stomach, which serves as a food reservoir, has been reduced in its capacity by the surgery. Other surgical procedures that often accompany gastrectomy for ulcer disease can also contribute to later symptoms. These procedures include vagotomy, which lessens acid production and slows stomach emptying; and pyloroplasty, which enlarges the opening between the stomach and small intestine to facilitate emptying of the stomach.

Some patients experience lightheadedness, heart palpitations or racing heart, sweating, and nausea and vomiting after a meal. These may be symptoms of "dumping syndrome," as food is rapidly dumped into the small intestine from the stomach. Dumping syndrome is treated by adjusting the diet and pattern of eating, for example, eating smaller, more frequent meals and limiting liquids.

Patients who have abdominal bloating and pain after eating, frequently followed by nausea and vomiting, may have what is called the "afferent loop syndrome." This is treated by surgical correction. Patients who have early satiety (feeling of fullness after eating), abdominal discomfort, and vomiting may have bile reflux gastritis (also called bilious vomiting), which is also surgically correctable. Many patients also experience weight loss.

Reactive hypoglycemia is a condition that results when blood sugar levels become too high after a meal, stimulating the release of insulin, occurring about two hours after eating. A high-protein diet and smaller meals are advised.

Ulcers recur in a small percentage of patients after surgery for peptic ulcer, usually in the first few years. Further surgery is usually necessary.

Vitamin and mineral supplementation is necessary after gastrectomy to correct certain deficiencies, especially vitamin B₁₂, iron, and folate. Vitamin D and calcium are also needed to prevent and treat the bone problems that often occur. These include softening and bending of the bones, which can produce pain and osteoporosis, a loss of bone mass. According to one study, the risk for spinal fractures may be as high as 50% after gastrectomy.