Postgastrectomy syndromes.

The preceding briefly summarizes some mechanical, metabolic, and motility disturbances that develop after gastric operations. Clearly, the more thorough the search and questions, the greater the incidence of minor, moderate, or severe impairment by one or more of these disorders. Our previous fears in treating benign ulcer disease were, first, mortality and, then, recurrent ulcers. Postgastrectomy syndromes were thought of secondarily. The seriousness, frequency, and lack of specific treatment available for most postgastrectomy syndromes were generally not recognized. While serious sequelae are infrequent, some take years to develop. A few, such as cancer, are regrettable even if treatable. Surgical correction of most of these syndromes is at best 50 to 80 percent effective. Poor selection of patients, mixed symptoms, and our inability to repiece vagus nerves and excised antrums make it difficult, if not impossible, to correct totally the anatomic and physiologic changes. Surgical intervention is infrequent. For some abnormalities, such as bile reflux gastritis, correction is uniformly good if gastric emptying is satisfactory and the syndrome exists alone. For others, such as dumping and diarrhea, treatment is less exacting, and the variety of operative alternatives often confuses rather than helps. My own continually changing experiences have taught me to correct the major disability in the simplest way. My experience with take-down of gastrojejunostomies and pyloroplasties is limited but encouraging. My satisfaction with Roux-en-Y conversions of Billroth II resections in reflux gastritis has been extended to the correction of diarrhea and dumping. Creating a long isoperistaltic limb between stomach and jejunum has provided surprisingly excellent relief for the problems of rapid emptying, although I have not objectively verified emptying changes in all successfully treated patients. The best results come with avoidance of these disorders. It is hoped that simpler operations for ulcer disease will continue to gain in popularity. Highly selective vagotomy is an easier, more attractive alternative than any of the aforementioned remedial procedures, particularly if the long-term results are good.