Postgastrectomy and Postvagotomy Syndromes

pp 125-147

Postgastrectomy Malabsorption

  • H. D. BeckerAffiliated withKlinik und Poliklinik für Allgemeinchirurgie
  • , W. F. CasparyAffiliated withII. Medizinische Klinik, Stadtkrankenhaus

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Although the majority of patients do relatively well following gastric surgery, some develop severe malabsorption and present difficult problems of nutritional management. Partial gastric resection was the procedure most frequently performed for peptic ulcer disease up to a decade ago and is still performed today. These patients, particularly those with Billroth II gastric resection, present potentially serious malabsorption problems. Weight loss commonly occurs after gastrectomy, the incidence being variously reported between 30% and 84% (1–13). The most common cause of postgastrectomy weight loss, although it may be multifactorial, is not malabsorption but inadequate food intake, due to poor appetite early sensations or fear of postcibal symptoms [7, 12]. Weight changes are found mostly in the first year after operation, but thereafter small changes are observed. Johnston et al. [12] observed that those patients who had lost weight prior to subtotal gastrectomy tended to gain afterwards, but those who had maintained a steady weight or had had an increase in weight before the operation tended to lose afterwards (Fig. 57). After truncal vagotomy, Wastell [13] found that the method of drainage (pyloroplasty or gastro-enterostomy) did not influence the loss of weight, and about half or more of the patients lost weight after vagotomy and drainage. Wheldon et al. [5] found a weight more than 4 kg below standard in 47% of men and in 64% of women after truncal vagotomy with gastro-enterostomy.