The first postgastrectomy syndrome was noted not long after the first gastrectomy was performed: Billroth reported a case of epigastric pain associated with bilious vomiting as a sequel of gastric surgery in 1885. Several classic treatises exist on the subject; we cannot improve on them and merely provide a few references for the interested reader. Surgical procedures on the stomach, performed for reasons such as peptic ulcer disease, cancer, obesity, or gastroesophageal reflux disease, can result in various post-gastrectomy syndromes. These syndromes include chronic symptoms that range from mild discomfort to life-altering conditions. This guide covers the most common syndromes and their characteristics.
GASTRECTOMY VIDEO SURGERY
Dumping Syndrome
Dumping Syndrome is characterized by gastrointestinal and vasomotor symptoms that occur after food intake due to rapid gastric emptying. This syndrome can occur after surgeries that alter the regulation of gastric emptying or gastric compliance, such as gastrectomy, proximal vagotomy, sleeve gastrectomy, fundoplication, pyloroplasty, and gastrojejunostomy (GJ). Depending on the speed of emptying and the osmolarity of gastric contents, symptoms can vary.
- Early Dumping: Occurs within 30 minutes after food intake and is characterized by palpitations, tachycardia, fatigue, a need to lie down after meals, flushing or pallor, sweating, dizziness, hypotension, headache, and possibly syncope. Abdominal symptoms include early satiety, epigastric fullness, abdominal pain, bloating, hypermotility, and splenic blood pooling.
- Late Dumping: Appears 1 to 3 hours after eating, due to reactive hypoglycemia caused by an initially high glucose load leading to an inappropriately high insulin response. Symptoms include sweating, faintness, difficulty concentrating, and altered levels of consciousness.
Diagnosis is confirmed through an oral glucose tolerance test or a gastric emptying scintigraphy study.
Post-Vagotomy Diarrhea
Post-vagotomy diarrhea is a common complication after vagotomy, characterized by frequent episodes of watery diarrhea. It can be attributed to changes in intestinal motility and bile secretion.
Gastric Stasis
Gastric stasis or delayed gastric emptying can occur due to disruption of normal gastric motility. Symptoms include nausea, vomiting, and a feeling of fullness. Diagnosis is confirmed through gastric emptying studies.
Bile Reflux Gastritis
Bile reflux gastritis is caused by the reflux of bile into the stomach, resulting in epigastric pain and bilious vomiting. Diagnosis can be confirmed through upper endoscopy and gastric pH monitoring.
Afferent and Efferent Loop Syndromes
Afferent loop syndrome occurs after Billroth II reconstruction and is characterized by abdominal pain, bilious vomiting, and distention. Efferent loop syndrome occurs when there is an obstruction of the efferent loop, leading to similar symptoms.
Roux Syndrome
Roux syndrome is a complication of Roux-en-Y procedures, characterized by postprandial abdominal pain and vomiting. Diagnosis is made through a contrast gastrointestinal transit study.
Therapeutic Approach
Management of post-gastrectomy syndromes includes dietary modifications, such as eating small frequent meals, separating liquids and solids, increasing protein and fat intake, and reducing simple sugars. In some cases, additional pharmacological or surgical interventions may be necessary. Understanding these syndromes and their therapeutic approaches is crucial to providing effective care and improving the quality of life for post-gastrectomy patients.
This article focuses on the small proportion of patients with severe, debilitating symptoms; these symptoms can challenge the acumen of the surgeon who is providing the patient’s long-term follow-up and care.
The SURGEON 