Postgastrectomy

Postgastrectomy denotes the period or condition following gastrectomy, a surgical procedure that removes part or all of the stomach. It is performed for gastric cancer, complex peptic ulcer disease, or other gastric conditions. Resection types include distal (subtotal) gastrectomy with Billroth I or Billroth II reconstruction, and total gastrectomy with esophagojejunostomy or Roux-en-Y reconstruction. The reconstruction chosen affects postoperative digestion and potential complications.

Postoperative care focuses on restoring nutrition while preventing complications. Immediate concerns include bleeding, infection, anastomotic leak, and pulmonary issues. Early feeding may begin with enteral nutrition and progressed to oral intake as tolerated. Patients are advised to eat small, frequent meals and to limit simple sugars to reduce dumping syndrome risk.

Long-term, patients may develop postgastrectomy syndrome, characterized by early or late dumping, postprandial fullness, cramps, diarrhea, sweating, or hypoglycemia after meals; weight loss is common. Nutritional deficiencies are frequent, especially vitamin B12 deficiency due to loss of intrinsic factor and reduced gastric acid, iron deficiency, calcium, and fat-soluble vitamins. Reflux and afferent loop or Roux stasis syndromes can occur, particularly after Billroth II procedures. Ulcers at the anastomosis and pouch-related issues may also arise.

Management emphasizes nutrition and monitoring. Lifelong follow-up includes monitoring for anemia, micronutrient deficiencies, and weight. B12 replacement is common after total gastrectomy or when intrinsic factor is lacking; iron, calcium, vitamin D, and multivitamin supplementation are often required. Dietary counseling and gradual reintroduction of foods aid adaptation.