postgastrectomy syndromes


Summary: Sequelae of gastrectomy from the second week after operation on. Include recurrent or anastomotic ulcer, postprandial syndromes (DUMPING SYNDROME and late postprandial hypoglycemia), disordered bowel action, and nutritional deficiencies.

Top Publications

  1. Tomita R, Fujisaki S, Tanjoh K. Pathophysiological studies on the relationship between postgastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancer. World J Surg. 2003;27:725-33 pubmed
    ..Epigastric fullness after meals continued in many patients after PPG. Thus the only disadvantage of the PPG procedure is the sensation of epigastric fullness and gastric stasis due to delayed gastric emptying of a semisolid diet. ..
  2. Rengo M, Bellini D, Iorio O, De Cecco C, Rizzello M, Cavallaro G, et al. Role of preoperative imaging with multidetector computed tomography in the management of patients with gastroesophageal reflux disease symptoms after laparoscopic sleeve gastrectomy. Obes Surg. 2013;23:1981-6 pubmed publisher
  3. Le Blanc Louvry I, Savoye G, Maillot C, Denis P, Ducrotte P. An impaired accommodation of the proximal stomach to a meal is associated with symptoms after distal gastrectomy. Am J Gastroenterol. 2003;98:2642-7 pubmed
    ..02). After distal gastrectomy, gastric accommodation is impaired (i.e., absent or delayed) in symptomatic patients. When relaxation exists in these patients, its amplitude is higher than in control subjects. ..
  4. Davis J, Ripley R. Postgastrectomy Syndromes and Nutritional Considerations Following Gastric Surgery. Surg Clin North Am. 2017;97:277-293 pubmed publisher
    b>Postgastrectomy syndromes result from altered form and function of the stomach. Gastrectomy disrupts reservoir capacity, mechanical digestion and gastric emptying...
  5. Migoh S, Hasuda K, Nakashima K, Anai H. The benefit of laparoscopy-assisted distal gastrectomy compared with conventional open distal gastrectomy: a case-matched control study. Hepatogastroenterology. 2003;50:2251-4 pubmed
    ..Laparoscopy-assisted distal gastrectomy is a safe and useful operation for most early gastric cancers. Laparoscopy-assisted distal gastrectomy has been superior to conventional open distal gastrectomy. ..
  6. Serra A, Sechi G, Singh S, Kumar A. Wernicke encephalopathy after obesity surgery: a systematic review. Neurology. 2007;69:615; author reply 615-6 pubmed
  7. Delgado Delgado R, Luque Vásquez C. [Does contribute early enteral nutrition to decrease the complications of radical gastrectomy for gastric cancer?]. Rev Gastroenterol Peru. 2011;31:146-50 pubmed
  8. Yan M, Chen G, Fang L, Liu Z, Zhang X. Immunologic changes to autologous transfusion after operational trauma in malignant tumor patients: neopterin and interleukin-2. J Zhejiang Univ Sci B. 2005;6:49-52 pubmed
    ..Autologous transfusion decreased the perioperative immune suppression in malignant stomach tumor patients. ..
  9. Dapri G, Himpens J, Buset M, Vasilikostas G, Ntounda R, Cadiere G. Video. Laparoscopic transgastric access to the common bile duct after Roux-en-Y gastric bypass. Surg Endosc. 2009;23:1646-8 pubmed publisher
    ..After 9 months, the patient was well and asymptomatic. Patients previously submitted to RYGBP and presenting choledocholithiasis can benefit from an ERCP through the gastric remnant. ..

More Information


  1. Baltasar A, Bou R, Bengochea M, Arlandis F, Escrivá C, Miro J, et al. Duodenal switch: an effective therapy for morbid obesity--intermediate results. Obes Surg. 2001;11:54-8 pubmed
    ..4% at 5 years when 97% of the patients had a %EWL > 50%. Comorbidities were cured or improved in all patients. DS was very effective for the treatment of the morbid obesity in the SO patients. ..
  2. Lindecken K, Salm B. [The effectiveness of Braun's anastomosis in Billroth II surgery. The role of hepatobiliary sequence scintigraphy (HBSS) in the diagnosis of bile flow following stomach resection]. Rofo. 1993;159:158-60 pubmed
    ..The high-grade HBSS data with regard to the biliary reflux proportions after gastric surgery and the low-grade effectiveness of Braun's entero-anastomosis are clearly evidenced...
  3. Schneider A, Holtmann G, Runzi M, Drochner K, Oldhafer K, Gerken G. [Gastrocolic fistula - a rare cause of cachexia and polyneuropathy]. Z Gastroenterol. 2002;40:521-4 pubmed
    ..Gastrocolic fistula is a rare cause of diarrhea and should be considered in clinical practice. Barium enema is superior to endoscopy in detecting gastrocolic fistula. ..
  4. Reyes García R, Jódar Gimeno E, García Martín A, Romero Muñoz M, Gómez Sáez J, Luque Fernández I, et al. [Clinical practice guidelines for evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions. Bone Metabolism Working Group of the Spanish Society of Endocrinology]. Endocrinol Nutr. 2012;59:174-96 pubmed publisher
  5. Kiciak A, Wolinski J, Borycka K, Zabielski R, Bielecki K. Roux-en-Y or 'uncut' Roux procedure? Relation of intestinal migrating motor complex recovery to the preservation of the network of interstitial cells of Cajal in pigs. Exp Physiol. 2007;92:399-408 pubmed
    ..In conclusion, in the pig model, preservation of smooth muscle and ICC network continuity in the proximal jejunum may play an important role in early postsurgical recovery. ..
  6. Aires Neto T, Cavalcante J, Brandao Neto J, Almeida M, de Rezende A, Egito E, et al. Total gastrectomy with substitution of stomach by jejunal pouch with and without duodenal passage. Study in rats. Acta Cir Bras. 2005;20 Suppl 1:167-72 pubmed
    ..05). F. Paulino pouch in rats had lower mortality than JP, and esophagitis was not detected in it. JP rats had serum gastrin, iron and calcium unaffected, possibly because of preservation of duodenal passage. ..
  7. Smedh U, Hansson L, Ekman R, Zilling T. Jejunal pouch reconstruction but not preservation of duodenal passage after total gastrectomy reduces plasma cholecystokinin and pancreatic polypeptide long term in pigs. In Vivo. 2009;23:93-8 pubmed
    ..J-pouch, but not preservation of duodenal passage after total gastrectomy, lowers levels of CCK and PP, peptides that reduce food intake. ..
  8. Schwarz A. [Pathophysiology of gastric pouch surgery]. Kongressbd Dtsch Ges Chir Kongr. 2002;119:265-8 pubmed
    ..Randomized studies demonstrate a better reservoir function, less reflux, less heart burn, a slower passage time and fewer dumping symptoms after pouch reconstruction. ..
  9. Rino Y, Suzuki Y, Kuroiwa Y, Yukawa N, Saeki H, Kanari M, et al. Vitamin E malabsorption and neurological consequences after gastrectomy for gastric cancer. Hepatogastroenterology. 2007;54:1858-61 pubmed
    ..Transport disturbance with loss of passage through the duodenum consequently may be the major cause of malabsorption. Differential diagnosis of neurological symptoms in post-gastrectomy patients should include hypovitaminosis E. ..
  10. Zoras O, Chrysos E, Tzovaras G, Fountos A, Vassilakis J, Xynos E. A composite score of enterogastric reflux quantitation on 99mTc-HIDA scintigraphy. Hepatogastroenterology. 1995;42:847-50 pubmed
  11. Tomita R, Fujisaki S, Tanjoh K, Fukuzawa M. Operative technique on nearly total gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of vagal nerve, lower esophageal sphincter, and pyloric sphincter for early gastric cancer. World J Surg. 2001;25:1524-31 pubmed
    ..05). The present results suggested that the surgical technique proposed is a function-preserving gastric surgery appropriate to prevent postgastrectomy disorder of subjects. ..
  12. Muller M. [Aftercare in patients with gastric cancer]. MMW Fortschr Med. 2008;150:34-6 pubmed
  13. Chan C, Liu S, Kho C, Lau K, Liang Y, Chu W, et al. Diagnostic clues to megaloblastic anaemia without macrocytosis. Int J Lab Hematol. 2007;29:163-71 pubmed
  14. Tauro L, Roshan M, Aithala P, Hegde B, Anand I, John S. A rare cause of haematemesis: retrograde jejunogastric intussusception. J Assoc Physicians India. 2006;54:333-5 pubmed
    ..Since gastrojejunostomies with vagotomy are on a declining trend, it is extremely rare to come across such a complication. We report such a case that presented with haematemesis. ..
  15. Xynos E, Vassilakis J, Fountos A, Pechlivanides G, Karkavitsas N. Enterogastric reflux after various types of antiulcer gastric surgery: quantitation by 99mTc-HIDA scintigraphy. Gastroenterology. 1991;101:991-8 pubmed
    ..Sixteen of these patients underwent Roux-en-Y gastrectomy and their preoperative symptoms were relieved. ..
  16. Zingg U, Oertli D. [Functional syndromes after surgery of the upper gastrointestinal tract]. Ther Umsch. 2012;69:39-47 pubmed publisher
    ..Detailed preoperative information of the procedure and multidisciplinary postoperative treatment (general practitioner, surgeon, gastroenterologist etc.) of evolving functional syndromes is mandatory to achieve a high standard of care. ..
  17. Kato T, Akiyama N, Motoyama H, Arai F, Inayoshi J, Funakoshi K. [Postgastrectomy syndrome and its management]. Nihon Naika Gakkai Zasshi. 2005;94:80-4 pubmed
  18. Morar P, Aziz O, Holme T. Management of jejunal pouch dysfunction following total gastrectomy and Roux-en-Y reconstruction for gastric cancer: a case report. Ann R Coll Surg Engl. 2012;94:e113-5 pubmed publisher
    ..A pouch-enteric bypass is a suitable treatment option for patients with functional jejunal pouch dysmotility following a total gastrectomy and jejunal pouch formation in the absence of distal obstruction and recurrent disease. ..
  19. Takase M, Sumiyama Y, Nagao J. Quantitative evaluation of reconstruction methods after gastrectomy using a new type of examination: digestion and absorption test with stable isotope 13C-labeled lipid compound. Gastric Cancer. 2003;6:134-41 pubmed
  20. Ohwada S, Nakamura S, Ogawa T, Izumi M, Tanahashi Y, Sato Y, et al. Segmental gastrectomy for early cancer in the mid-stomach. Hepatogastroenterology. 1999;46:1229-33 pubmed
    ..Their body weight and dietary volume returned to pre-operative levels within 12 months of surgery. Patients who underwent segmental gastrectomy have had a reasonably good quality of life in the post-operative follow-up to date. ..
  21. Lee J, Hur H, Kim W. Improved long-term quality of life in patients with laparoscopy-assisted distal gastrectomy with jejunal pouch interposition for early gastric cancer. Ann Surg Oncol. 2010;17:2024-30 pubmed publisher
    ..In this paper, we investigate jejunal pouch interposition (JPI) during LADG and evaluate its potential for long-term use...
  22. Fujimura T, Fushida S, Kayahara M, Ohta T, Kinami S, Miwa K. Transectional gastrectomy: an old but renewed concept for early gastric cancer. Surg Today. 2010;40:398-403 pubmed publisher
    ..Future confirmation of the sentinel node concept through a multi-institutional validation study conducted by the Japanese Society of Sentinel Node Navigation Surgery would lead to widespread adoption of transectional gastrectomy. ..
  23. Mikhaĭlov A, Danilov A, Napalkov A, Romanenko O. [Long-term results of pylorus-preserving gastric resections]. Vestn Khir Im I I Grek. 2002;161:87-90 pubmed
    ..An analysis of the causes of complications was made as well as the substantiation of the methods of reconstructive interventions. Indications and contraindications for pylorus-preserving resections of the stomach are proposed. ..
  24. Adachi S, Inagawa S, Enomoto T, Shinozaki E, Oda T, Kawamoto T. Subjective and functional results after total gastrectomy: prospective study for longterm comparison of reconstruction procedures. Gastric Cancer. 2003;6:24-9 pubmed
    ..reconstruction should be performed with pouch formation after total gastrectomy with curative intent. ..
  25. Morita S, Sasako M, Saka M, Fukagawa T, Sano T, Katai H. Correlation between the length of the pyloric cuff and postoperative evaluation after pylorus-preserving gastrectomy. Gastric Cancer. 2010;13:109-16 pubmed publisher
    ..Regardless of the length of the pyloric cuff, pylorus-preserving gastrectomy can be utilized for the treatment of early gastric cancer even if the tumor is located proximal to the middle body. ..
  26. Nomura E, Isozaki H, Fujii K, Toyoda M, Niki M, Sako S, et al. Postoperative evaluation of function-preserving gastrectomy for early gastric cancer. Hepatogastroenterology. 2003;50:2246-50 pubmed
  27. Kiyama T, Mizutani T, Okuda T, Fujita I, Tokunaga A, Tajiri T, et al. Postoperative changes in body composition after gastrectomy. J Gastrointest Surg. 2005;9:313-9 pubmed
    ..Bioelectric impedance analysis can be used to assess body composition and may be useful for nutritional assessment in patients who have undergone gastrectomy. ..
  28. Kumar N, Gross J, Ahlskog J. Copper deficiency myelopathy produces a clinical picture like subacute combined degeneration. Neurology. 2004;63:33-9 pubmed
    ..The clinical picture bears striking similarities to the syndrome of subacute combined degeneration associated with vitamin B12 deficiency. Early recognition and copper supplementation may prevent neurologic deterioration. ..
  29. Krumwiede K. [Patient after stomach resection. What and how he should eat]. MMW Fortschr Med. 2003;145:28-31 pubmed
    ..With increasing time after the operation, alimentation problems usually abate, but in the individual case may persist for years. ..
  30. Scholmerich J. Postgastrectomy syndromes--diagnosis and treatment. Best Pract Res Clin Gastroenterol. 2004;18:917-33 pubmed
    ..Dietary measures, rarely re-operation, and in particular adequate follow-up of metabolic and nutrition parameters with consequent substitution are the main therapeutic necessities. ..
  31. Speicher J, Thirlby R, Burggraaf J, Kelly C, Levasseur S. Results of completion gastrectomies in 44 patients with postsurgical gastric atony. J Gastrointest Surg. 2009;13:874-80 pubmed publisher
    ..Patient satisfaction is high; about 78% of patients believed their health status is improved. We believe these data support the selective use of completion gastrectomies in patients with severe postsurgical gastroparesis. ..
  32. Leivonen M, Juuti A, Jaser N, Mustonen H. Laparoscopic sleeve gastrectomy in patients over 59 years: early recovery and 12-month follow-up. Obes Surg. 2011;21:1180-7 pubmed publisher
    ..Although operative treatment of older bariatric patients is safe, their postoperative care is demanding considering vitamins and protein. ..
  33. Murawa D, Murawa P, Oszkinis G, Biczysko W. Long-term consequences of total gastrectomy: quality of life, nutritional status, bacterial overgrowth and adaptive changes in esophagojejunostomic mucosa. Tumori. 2006;92:26-33 pubmed
    ..The aim of the study was to evaluate long-term quality of life and adaptive changes in the mucosa of the proximal section of the small intestine used for esophagojejunostomy reconstruction in stomach cancer patients after total gastrectomy...
  34. Simonetti G, Meloni G, Conti M, Profili S, Bifulco V, Puoti G, et al. [The radiological study of afferent and efferent loop syndromes]. Radiol Med. 1991;82:625-8 pubmed
    ..Both the duration of follow-up (early and late controls) and the choice of contrast (water-soluble contrast medium or double contrast enema) are very important factors depending on the time of surgery and the clinical indication. ..
  35. Li V, Pulido N, Fajnwaks P, Szomstein S, Rosenthal R, Martinez Duartez P. Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy. Surg Endosc. 2009;23:1640-4 pubmed publisher
    ..Weight loss of more than 25% of original weight was the only postoperative factor that can help selecting patients for postoperative ultrasound surveillance and subsequent cholecystectomy once gallstones were identified. ..
  36. Acar T, Tuncal S, Aydin R. An unusual cause of gastrointestinal obstruction: bezoar. N Z Med J. 2003;116:U422 pubmed
  37. Tomita R. Gastric emptying function in patients 5 years after pylorus-preserving distal gastrectomy with or without preserving pyloric and hepatic branches of the vagal nerve for early gastric cancer. World J Surg. 2009;33:2119-26 pubmed publisher
  38. Tan J, Burns D, Jones H. Severe ataxia, myelopathy, and peripheral neuropathy due to acquired copper deficiency in a patient with history of gastrectomy. JPEN J Parenter Enteral Nutr. 2006;30:446-50 pubmed
    ..Early recognition and therapy with oral or parenteral copper may lead to a decrease in both neurologic and hematologic consequences. ..
  39. Fujita J, Takahashi M, Urushihara T, Tanabe K, Kodera Y, Yumiba T, et al. Assessment of postoperative quality of life following pylorus-preserving gastrectomy and Billroth-I distal gastrectomy in gastric cancer patients: results of the nationwide postgastrectomy syndrome assessment study. Gastric Cancer. 2016;19:302-11 pubmed publisher
    ..It has been suggested that PPG is superior to DGBI for ameliorating PGS. Preservation of the celiac branch of the vagus nerve is recommended to reduce postoperative disorders regardless of the reconstruction method used. ..
  40. Arlt G, Peiper C, Winkeltau G, Schumpelick V. [Billroth I hemigastrectomy in complicated recurrent ulcer after selective proximal vagotomy]. Langenbecks Arch Chir. 1993;378:341-4 pubmed
    ..Distal gastric resection with a Billroth I anastomosis for complicated recurrent ulcer after PSV proved to involve only low morbidity and to effect reliable prophylaxis of ulcer recurrence in the long term. ..
  41. Jung H, Lee J, Ryu K, Lee J, Kim C, Choi I, et al. The influence of reconstruction methods on food retention phenomenon in the remnant stomach after a subtotal gastrectomy. J Surg Oncol. 2008;98:11-4 pubmed publisher
    ..The aim of this study was to determine whether reconstruction methods after the distal subtotal gastrectomy influenced the degree of food residue and bile reflux...
  42. Tomita R, Ikeda T, Fujisaki S, Koshinaga T, Tanjoh K. Effects of mosapride citrate on patients after vagal nerve preserving distal gastrectomy reconstructed by interposition of a jejunal J pouch with a jejunal conduit for early gastric cancer. World J Surg. 2006;30:205-12 pubmed
    ..It is possible that MS therapy improves abdominal fullness due to the postprandial stasis in the substitute stomach, contributing to the improvement of QOL of patients after DGP. ..
  43. Tomita R, Fujisaki S, Tanjoh K, Fukuzawa M. A novel operative technique on proximal gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of the vagal nerve and lower esophageal sphincter. Hepatogastroenterology. 2001;48:1186-91 pubmed
    ..Therefore, this method is useful for preventing the postoperative disorders in patients with early gastric cancer located in the proximal third of the stomach. ..
  44. Rangarajan M, Subramanian C, Chandralathan T, Senthilkumar G. Laparoscopic jejuno-jejunostomy for afferent loop stasis following truncal vagotomy with posterior gastro-jejunostomy for pyloric stenosis. Indian J Gastroenterol. 2006;25:37-8 pubmed
    ..Endoscopy showed distension and stasis in the afferent loop, bile gastritis and esophagitis. Laparoscopic Braun jejunojejunostomy relieved his symptoms. ..
  45. Nafil H, Tazi I, Sifessalam M, Bouchtia M, Mahmal L. [Clinical, biological and therapeutic profile of anemia by vitamin B12 deficiency in the department of hematology of Marrakech (Morocco)]. Bull Soc Pathol Exot. 2013;106:83-8 pubmed publisher
    ..In patients with HP infection, eradication therapy of HP was performed. The cure rate of the HP is 90%. ..
  46. Kubo M, Sasako M, Gotoda T, Ono H, Fujishiro M, Saito D, et al. Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer. 2002;5:83-9 pubmed
    ..The results suggest some important differences among methods of reconstruction. This classification seems to be useful to describe these findings and to further evaluate these reconstructive methods. ..
  47. Dikic S, Randjelovic T, Dragojević S, Bilanovic D, Granic M, Gacic D, et al. Early dumping syndrome and reflux esophagitis prevention with pouch reconstruction. J Surg Res. 2012;175:56-61 pubmed publisher
    ..Our study showed significant superiority of the new pouch reconstruction over the standard Roux-en-Y approach in the treatment of early dumping syndrome. ..
  48. Gokgoz S, Koyluoglu G, Saraydin S, Kaya T, Gursoy S, Sen M. Altered contractile responsiveness in ileal longitudinal muscle after total gastrectomy in a rat model. Surg Today. 2004;34:138-44 pubmed
    To test the hypothesis that the changes in ileal smooth muscle contractility accompanying postgastrectomy syndromes are agonist-specific, we investigated the effects of potassium chloride (KCl), carbachol, substance P (SP), and serotonin ..
  49. Beyan C, Beyan E, Kaptan K, Ifran A, Uzar A. Post-gastrectomy anemia: evaluation of 72 cases with post-gastrectomy anemia. Hematology. 2007;12:81-4 pubmed
    ..In conclusion, gastrectomized patients should be followed for anemia and treated appropriately based on the cause of anemia. ..
  50. 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;26:1452-7 pubmed
    ..Roux-Y reconstruction is superior to either Billroth I or II reconstruction for preventing bile reflux into the gastric remnant and esophagus after distal gastrectomy. ..
  51. Zuber Jerger I, Scholmerich J, Klebl F. [Chronic diseases after gastrointestinal surgery]. Internist (Berl). 2006;47:242, 244-6, 248-51 pubmed
    ..Some negative effects can be avoided by early therapeutic interventions. This article summarizes typical chronic consequences of gastrointestinal surgery. ..
  52. Smedh U, Hansson L, Ekman R, Zilling T. Total gastrectomy causes a sustained, long-term elevation of somatostatin in plasma, independent of the mode of reconstruction in pigs. In Vivo. 2009;23:99-103 pubmed
    ..TG by itself leads to high levels of somatostatin long term, however, somatostatin, motilin, neurotensin and VIP are unaffected by the mode of reconstruction. ..
  53. Oshita H, Tanemura H, Kanno A, Kusakabe M, Hato T, Tomita E, et al. Malignant lymphoma occurring in the residual stomach following gastrectomy: plus discussion based on the literature in Japan. Gastric Cancer. 2003;6:60-3 pubmed
    ..Although malignant lymphoma occurring in the residual stomach following gastrectomy is rare, particular attention should be given to the possible presence of a malignant tumor when examining the residual stomach following gastrectomy. ..