Malabsorption syndromes in the postgastrectomy patient

Summary and Conclusions

In summary, operations for duodenal ulcer may result in rather distressing postoperative weight loss which may be so severe as to prove incapacitating. One must certainly anticipate an undesirable influence on intestinal absorption. This factor, combined with a limited food intake, regardless of cause, plays a major role in the nutritional problems seen following gastric resection. Furthermore, these effects may be minimized by a lesser resection, restoration of normal bowel continuity by using a gastroduodenostomy, and possibly by construction of a smaller stomal opening.

Close attention to the dietary management, starting early in the postoperative period, employing seasoned solid foods of minimal volume and low bulk, and avoiding hypertonic fluids, results in an improved intake and minimal distress after meals. Unsatisfactory weight trends should be anticipated in patients whose preoperative weight levels are below their ideal weight, and a more conservative operation for control of the gastric acidity should be considered.

Finally, the surgeon must either accept or share the responsibility for the complete postoperative rehabilitation of the ulcer patient. Good technical surgery is not sufficient to assure a good end result. In addition to being acquainted with gastric physiology, the surgeon must have a thorough understanding of gastric philosophy as well. The quality of life after operation for ulcer should be our major criterion of success.