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Postgastrectomy Complications: Partial Gastrectomy
Complications in the postgastrectomy period occur with both open and laparoscopic surgical techniques and may occur after complete healing. These include recurrent ulceration, gastroparesis (delayed gastric emptying), afferent loop syndrome, dumping syndrome and postvagotomy diarrhea, bile reflux gastritis, and gastric adenocarcinoma. Symptoms vary depending on the complication and are briefly described here.
Recurrent Ulceration
Marginal ulcers, or jejunal ulcers, are rare and may occur in less than 1% of postgastrectomy patients. These ulcers usually are caused by inadequate acid suppression, which is highly unlikely since the advent of proton pump inhibitors (PPIs), and Zollinger-Ellison syndrome is always suspected. Taking nonsteroidal antiinflammatory drugs (NSAIDs) can cause ulceration. The presenting symptom is most frequently pain, although occult bleeding and anemia have been reported. Endoscopic evaluation provides the diagnosis. Endoscopy and biopsy are essential to rule out early malignant carcinoma. These lesions can be controlled by removal of irritating drugs and PPI acid suppression. Although rarely required as treatment, if carcinoma is present, surgical resection is paramount.
Gastroparesis (Delayed Gastric Emptying)
Gastroparesis is most often associated with truncal vagotomy or basic motility disturbance, as occurs in diabetes. The symptom usually is nausea or inability to eat and occasionally, vomiting of feedings. Attempts at medical treatment with prokinetic agents, such as metoclopramide or erythromycin, may be of help. Some patients have gastroparesis before their surgery, and treatment is complicated (see Chapter 4 ).
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