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Gastrectomy

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Submitted By amholcomb
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Digestion
Having a subtotal gastrectomy comes with many lifestyle changes. There will be many struggles and issues that the patient will have to overcome, involving the digestion and absorption of foods, after the surgery is performed. Some of these issues include: dumping syndrome, vitamin and mineral malabsorption, and also changing eating habits drastically.
This first issue is dumping syndrome. Dumping syndrome is named from the effect of food being "dumped" too quickly into the intestines, resulting in symptoms such as dizziness, cramping, nausea and diarrhea2. This usually begins 15-30 after eating1. This syndrome occurs because the stomach, after the surgery, cannot withstand the amount of food or foods with large amounts of sugar. Also, meals with an excessive amount of carbohydrates can cause dumping syndrome. Some ways to help control this it to eat slowly and chew foods well, sit upright while eating, do not drink as much while eating, eat more protein with meals, and eat high fiber foods when possible1.
Another issue after a subtotal gastrectomy is vitamin and mineral malabsorption. The problem is cause because parts of the digestive system that prior to the surgery would separate nutrients from food are no longer there. The parts remove are normally the large cross section of the stomach and also the duodenum3. A lot of times this issue can be controlled by taking vitamin supplements. Anemia and metabolic bone disease are common so iron, vitamin B12, folic acid, calcium, and vitamin D are usually supplemented1.
More issues that patients have complained with after the surgery is lactose intolerance which include them having cramping, bloating, flatulence, and distention after consuming lactose1. Another problem that has been found is gastric stasis. Some of the symptoms include bloating, and discomfort or fullness lasting for long periods of time1. The patients that have this are at high risk for bezoar formation, growth of bacteria, and intolerance to solid food1.People who undergo a total gastrectomy would have to change their eating habits drastically. After having surgery, the body will not allow overeating or eating certain things. It is suggested that instead of eating three large meals to eat several small ones to prevent overeating2. Also, after surgery, consuming clear liquids and soft low-fiber foods are suggested3 .
During the gastric bypass surgery the surgeons create a pouch by cutting, then stapling the upper portion of the stomach1. The pouch created is the size of a small egg1. Next, they will measure 100-150 cm of small bowel then cut, staple, and reconnect the small bowel to the pouch1. Finally, they reconnect the small bowel to the lower portion of the small bowel so when the surgery is complete the large stomach will empty juices containing bile from the gallbladder and enzymes from the pancreas into the small bowel1.
Another type of bariatric surgery is the LAP-BAND. To begin this surgery the surgeon creates a small 1cm incision in the abdominal area to place around the upper part of the stomach5. The concept of this type of surgery is to create a pouch in the upper region of the stomach that contains an adjustable and controlled stoma, that does not include stapling to limit the food intake5. The band that is placed around the stomach has a balloon on the inside that helps control fullness5. The LAP BAND procedure can take anywhere from 30 minutes to 1 hour5. After the surgery is completed the balloon placed around the stomach can be inflated or deflated at any time to help continue weight loss5.
A third type of bariatric surgery would be the Gastric Sleeve. During this laparoscopic procedure, 85 percent of the stomach is removed taking the shape of a sleeve6. After making a small incision a tube is inserted with a camera and other small instruments to remove the portion of the stomach6. After the removal of the stomach the rest is sealed up with staples6. Some people, after the gastric sleeve surgery, opt to have the gastric bypass surgery to help to continue losing weight6. The bypass surgery is less dangerous after having the gastric sleeve performed first. If they do chose this route, the second surgery can be done six to 18 months after the first6.
There are many routes that people could take when considering this type of surgery. When battling obesity and diet and exercise do not work this would be a good option. It does come with many side effects and problems, but so does being overweight. If handled correctly this could be very beneficial to people that struggle with their weight. Every surgery could have complications and a total gastrectomy is no different. The patient would have to follow the guidelines and take care of themselves. It would be a long road, but would definitely be worth it in most cases.

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