Gastric stasis (also called gastric atony or gastroparesis) results from two postgastrectomy derangements. Vagotomy decreases the frequency and amplitude of gastric contractions. Gastric resection disturbs the motility of the stomach, also impairing gastric emptying. These patients have postprandial epigastric pain, nausea, and vomiting of partially digested food eaten hours or even days before. They may be malnourished and
often restrict themselves to a liquid diet, which is tolerated better than solids. Bezoars are common and are seen in up to 12% of postgastrectomy patients (14). Gastric atony (Fig. 9) is a major complication of gastric surgery. This may be further exacerbated by diabetes, hypothyroidism, and neurologic disorders. It is important to determine whether the impedence to gastric outflow is mechanical or functional. Endoscopy, contrast radiography, and scintigraphy usually allow differentiation.
Medical therapy with prokinetic agents such as metoclopramide and erythromycin has limited success. Severely symptomatic patients generally require revisional surgery. Because vagal innervation cannot be restored, operative therapy is aimed at decreasing the reservoir capacity of the stomach. A near-total gastric resection removes the atonic stomach, and a Roux-en-Y reconstruction is needed to prevent bile reflux esophagitis.
A subtype of the gastric stasis syndrome is the Roux Stasis Syndrome. Patients with the Roux-en-Y gastroenterostomy are at especially high risk for delayed gastric emptying. This is caused by disordered motility in the Roux limb, which increases the resistance to gastric emptying. Truncal vagotomy may also diminish the strength of Roux contractions. Roux stasis syndrome is especially resistant to medical treatment and often requires near total gastrectomy with Roux-en-Y gastrojejunostomy. Even after near-total gastrectomy, persistence of significant Roux stasis syndrome is present in up to one-third of patients. The only surgical option at this point is a gastric reservoir procedure, which has unpredictable results in this patient group.
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