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Postgastrectomy Syndromes

  • George Z. Li
  • Stanley W. AshleyEmail author
Chapter

Abstract

Postgastrectomy syndromes occur due to loss of pyloric function or normal vagal innervation after gastrectomy or vagotomy with or without drainage. The choice of gastrointestinal reconstruction also affects the type of symptoms that a particular patient develops. Postgastrectomy syndromes can be categorized as rapid-transit or slow-transit disorders. Rapid-transit disorders include dumping syndrome and post-vagotomy diarrhea, while slow-transit disorders include delayed gastric emptying, alkaline reflux gastritis, and Roux limb stasis. Diagnostic evaluation involves a combination of clinical history, upper endoscopy, radiographic imaging such as an upper gastrointestinal series, and functional studies such as a gastric emptying study or a fasting oral glucose challenge. Management generally consists of an initial attempt at dietary modifications followed by a trial of medical therapy. Effective surgical options exist for each syndrome, but reoperation remains a last resort in each case.

Keywords

Postgastrectomy syndrome Dumping syndrome Alkaline reflux gastritis Roux limb stasis Delayed gastric emptying 

References

  1. 1.
    NIH consensus conference. Helicobacter pylori in peptic ulcer disease. NIH consensus development panel on helicobacter pylori in peptic ulcer disease. JAMA. 1994;272(1):65–9.Google Scholar
  2. 2.
    Yeomans ND, Tulassay Z, Juhasz L, Racz I, Howard JM, van Rensburg CJ, Swannell AJ, Hawkey CJ. A comparison of omeprazole with ranitidine for ulcers associated with nonsteroidal antiinflammatory drugs. Acid suppression trial: ranitidine versus omeprazole for NSAID-associated ulcer treatment (ASTRONAUT) study group. N Engl J Med. 1998;338(11):719–26.  https://doi.org/10.1056/NEJM199803123381104.CrossRefPubMedGoogle Scholar
  3. 3.
    Anderson WF, Camargo MC, Fraumeni JF Jr, Correa P, Rosenberg PS, Rabkin CS. Age-specific trends in incidence of noncardia gastric cancer in US adults. JAMA. 2010;303(17):1723–8.  https://doi.org/10.1001/jama.2010.496.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Wang YR, Richter JE, Dempsey DT. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg. 2010;251(1):51–8.  https://doi.org/10.1097/SLA.0b013e3181b975b8.CrossRefGoogle Scholar
  5. 5.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30.  https://doi.org/10.3322/caac.21332.CrossRefGoogle Scholar
  6. 6.
    Bolton JS, Conway WC 2nd. Postgastrectomy syndromes. Surg Clin North Am. 2011;91(5):1105–22.  https://doi.org/10.1016/j.suc.2011.07.001.CrossRefPubMedGoogle Scholar
  7. 7.
    Livingston EH. The incidence of bariatric surgery has plateaued in the U.S. Am J Surg. 2010;200(3):378–85.  https://doi.org/10.1016/j.amjsurg.2009.11.007.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Thompson BW, Read RC. Long-term randomized prospective comparison of Finney and Heineke-Mikulicz pylorplasty in patients having vagotomy for peptic ulceration. Am J Surg. 1975;129(1):78–81.CrossRefGoogle Scholar
  9. 9.
    Ishikawa K, Arita T, Ninomiya S, Bandoh T, Shiraishi N, Kitano S. Outcome of segmental gastrectomy versus distal gastrectomy for early gastric cancer. World J Surg. 2007;31(11):2204–7.  https://doi.org/10.1007/s00268-007-9192-2.CrossRefPubMedGoogle Scholar
  10. 10.
    Park DJ, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg. 2008;32(6):1029–36.  https://doi.org/10.1007/s00268-007-9441-4.CrossRefPubMedGoogle Scholar
  11. 11.
    Fukuhara K, Osugi H, Takada N, Takemura M, Higashino M, Kinoshita H. Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux. World J Surg. 2002;26(12):1452–7.  https://doi.org/10.1007/s00268-002-6363-z.CrossRefPubMedGoogle Scholar
  12. 12.
    Barnett WO, Tucker FH Jr. Management of the Difficult Duodenal Stump. Ann Surg. 1964;159:794–801.CrossRefGoogle Scholar
  13. 13.
    Burch JM, Cox CL, Feliciano DV, Richardson RJ, Martin RR. Management of the difficult duodenal stump. Am J Surg. 1991;162(6):522–6.CrossRefGoogle Scholar
  14. 14.
    Degiuli M, Sasako M, Ponti A, Soldati T, Danese F, Calvo F. Morbidity and mortality after D2 gastrectomy for gastric cancer: results of the Italian Gastric Cancer Study Group prospective multicenter surgical study. J Clin Oncol. 1998;16(4):1490–3.CrossRefGoogle Scholar
  15. 15.
    Wells CA, Macphee IW. The afferent-loop syndrome: bilious regurgitation after subtotal gastrectomy and its relief. Lancet. 1952;2(6747):1189–93.CrossRefGoogle Scholar
  16. 16.
    van der Mijle HC, Kleibeuker JH, Limburg AJ, Bleichrodt RP, Beekhuis H, van Schilfgaarde R. Manometric and scintigraphic studies of the relation between motility disturbances in the Roux limb and the Roux-en-Y syndrome. Am J Surg. 1993;166(1):11–7.CrossRefGoogle Scholar
  17. 17.
    Hertz AF. The cause and treatment of certain unfavourable after-effects of gastro-enterostomy. Proc R Soc Med. 1913;6(Surg Sect):155–63.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Ukleja A. Dumping syndrome: pathophysiology and treatment. Nutr Clin Pract. 2005;20(5):517–25.CrossRefGoogle Scholar
  19. 19.
    Eagon JC, Miedema BW, Kelly KA. Postgastrectomy syndromes. Surg Clin North Am. 1992;72(2):445–65.CrossRefGoogle Scholar
  20. 20.
    Azpiroz F, Malagelada JR. Gastric tone measured by an electronic barostat in health and postsurgical gastroparesis. Gastroenterology. 1987;92(4):934–43.CrossRefGoogle Scholar
  21. 21.
    Sirinek KR, O’Dorisio TM, Howe B, McFee AS. Neurotensin, vasoactive intestinal peptide, and Roux-en-Y gastrojejunostomy. Their role in the dumping syndrome. Arch Surg. 1985;120(5):605–9.CrossRefGoogle Scholar
  22. 22.
    Holdsworth CD, Turner D, McIntyre N. Pathophysiology of post-gastrectomy hypoglycaemia. Br Med J. 1969;4(5678):257–9.CrossRefGoogle Scholar
  23. 23.
    van der Kleij FG, Vecht J, Lamers CB, Masclee AA. Diagnostic value of dumping provocation in patients after gastric surgery. Scand J Gastroenterol. 1996;31(12):1162–6.CrossRefGoogle Scholar
  24. 24.
    Geer RJ, Richards WO, O’Dorisio TM, Woltering EO, Williams S, Rice D, Abumrad NN. Efficacy of octreotide acetate in treatment of severe postgastrectomy dumping syndrome. Ann Surg. 1990;212(6):678–87.CrossRefGoogle Scholar
  25. 25.
    Hopman WP, Wolberink RG, Lamers CB, Van Tongeren JH. Treatment of the dumping syndrome with the somatostatin analogue SMS 201-995. Ann Surg. 1988;207(2):155–9.CrossRefGoogle Scholar
  26. 26.
    Mackie CR, Jenkins SA, Hartley MN. Treatment of severe postvagotomy/postgastrectomy symptoms with the somatostatin analogue octreotide. Br J Surg. 1991;78(11):1338–43.CrossRefGoogle Scholar
  27. 27.
    Vecht J, Lamers CB, Masclee AA. Long-term results of octreotide-therapy in severe dumping syndrome. Clin Endocrinol. 1999;51(5):619–24.CrossRefGoogle Scholar
  28. 28.
    Hasegawa T, Yoneda M, Nakamura K, Ohnishi K, Harada H, Kyouda T, Yoshida Y, Makino I. Long-term effect of alpha-glucosidase inhibitor on late dumping syndrome. J Gastroenterol Hepatol. 1998;13(12):1201–6.PubMedGoogle Scholar
  29. 29.
    Duncombe VM, Bolin TD, Davis AE. Double-blind trial of cholestyramine in post-vagotomy diarrhoea. Gut. 1977;18(7):531–5.CrossRefGoogle Scholar
  30. 30.
    Ayulo JA. Cholestyramine in postvagotomy syndrome. Preliminary report. Am J Gastroenterol. 1972;57(3):207–25.PubMedGoogle Scholar
  31. 31.
    Herrington JL Jr, Sawyers JL. A new operation for the dumping syndrome and post-vagotomy diarrhea. Ann Surg. 1972;175(5):790–801.CrossRefGoogle Scholar
  32. 32.
    Jung HJ, Lee JH, Ryu KW, Lee JY, Kim CG, Choi IJ, Kim YW, Bae JM. The influence of reconstruction methods on food retention phenomenon in the remnant stomach after a subtotal gastrectomy. J Surg Oncol. 2008;98(1):11–4.  https://doi.org/10.1002/jso.21076.CrossRefPubMedGoogle Scholar
  33. 33.
    Forster J, Sarosiek I, Delcore R, Lin Z, Raju GS, McCallum RW. Gastric pacing is a new surgical treatment for gastroparesis. Am J Surg. 2001;182(6):676–81.CrossRefGoogle Scholar
  34. 34.
    Bechi P, Amorosi A, Mazzanti R, Romagnoli P, Tonelli L. Gastric histology and fasting bile reflux after partial gastrectomy. Gastroenterology. 1987;93(2):335–43.CrossRefGoogle Scholar
  35. 35.
    Attwood SE, Smyrk TC, DeMeester TR, Mirvish SS, Stein HJ, Hinder RA. Duodenoesophageal reflux and the development of esophageal adenocarcinoma in rats. Surgery. 1992;111(5):503–10.PubMedGoogle Scholar
  36. 36.
    Stefaniwsky AB, Tint GS, Speck J, Shefer S, Salen G. Ursodeoxycholic acid treatment of bile reflux gastritis. Gastroenterology. 1985;89(5):1000–4.CrossRefGoogle Scholar
  37. 37.
    Kennedy T, Green R. Roux diversion for bile reflux following gastric surgery. Br J Surg. 1978;65(5):323–5.CrossRefGoogle Scholar
  38. 38.
    Vogel SB, Drane WE, Woodward ER. Clinical and radionuclide evaluation of bile diversion by Braun enteroenterostomy: prevention and treatment of alkaline reflux gastritis. An alternative to Roux-en-Y diversion. Ann Surg. 1994;219(5):458–65; discussion 465–456CrossRefGoogle Scholar
  39. 39.
    Herrington JL Jr, Sawyers JL, Whitehead WA. Surgical management of reflux gastritis. Ann Surg. 1974;180(4):526–37.CrossRefGoogle Scholar
  40. 40.
    Gustavsson S, Ilstrup DM, Morrison P, Kelly KA. Roux-Y stasis syndrome after gastrectomy. Am J Surg. 1988;155(3):490–4.CrossRefGoogle Scholar
  41. 41.
    Miedema BW, Kelly KA, Camilleri M, Hanson RB, Zinsmeister AR, O’Connor MK, Brown ML. Human gastric and jejunal transit and motility after Roux gastrojejunostomy. Gastroenterology. 1992;103(4):1133–43.CrossRefGoogle Scholar
  42. 42.
    Mitty WF Jr, Grossi C, Nealon TF Jr. Chronic afferent loop syndrome. Ann Surg. 1970;172(6):996–1001.CrossRefGoogle Scholar
  43. 43.
    Lundegardh G, Adami HO, Helmick C, Zack M, Meirik O. Stomach cancer after partial gastrectomy for benign ulcer disease. N Engl J Med. 1988;319(4):195–200.  https://doi.org/10.1056/NEJM198807283190402.CrossRefPubMedGoogle Scholar
  44. 44.
    Viste A, Bjornestad E, Opheim P, Skarstein A, Thunold J, Hartveit F, Eide GE, Eide TJ, Soreide O. Risk of carcinoma following gastric operations for benign disease. A historical cohort study of 3470 patients. Lancet. 1986;2(8505):502–5.CrossRefGoogle Scholar
  45. 45.
    Surgery ASfMaB. Estimate of bariatric surgery numbers. 2011-2015. 2016. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed 10 Oct 2016.
  46. 46.
    Mallory GN, Macgregor AM, Rand CS. The influence of dumping on weight loss after gastric restrictive surgery for morbid obesity. Obes Surg. 1996;6(6):474–8.  https://doi.org/10.1381/096089296765556368.CrossRefPubMedGoogle Scholar
  47. 47.
    Patel RA, Brolin RE, Gandhi A. Revisional operations for marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(3):317–22.  https://doi.org/10.1016/j.soard.2008.10.011.CrossRefPubMedGoogle Scholar
  48. 48.
    Dapri G, Cadiere GB, Himpens J. Laparoscopic seromyotomy for long stenosis after sleeve gastrectomy with or without duodenal switch. Obes Surg. 2009;19(4):495–9.  https://doi.org/10.1007/s11695-009-9803-0.CrossRefPubMedGoogle Scholar
  49. 49.
    Yehoshua RT, Eidelman LA, Stein M, Fichman S, Mazor A, Chen J, Bernstine H, Singer P, Dickman R, Beglaibter N, Shikora SA, Rosenthal RJ, Rubin M. Laparoscopic sleeve gastrectomy--volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.  https://doi.org/10.1007/s11695-008-9576-x.CrossRefPubMedGoogle Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.Department of SurgeryBrigham and Women’s HospitalBostonUSA
  2. 2.Brigham and Women’s Hospital, Harvard Medical SchoolBostonUSA

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