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Fig. 3. Normal gastrografin swallow after total gastrectomy.

arily. A tightly stapled or hand-sewn anastomosis or ischemia at the anastomosis can lead to a stricture. Symptoms can present as dysphagia 1-6 wk following total gastrectomy. Almost all of these strictures can be treated with endoscopic dilations. The number of dilations is variable among patients, but two to three dilations are not uncommon.

A less common consequence of total gastrectomy is bile reflux. This can be effectively treated with Sucrafate. One of the primary reasons for this complication is construction of a short Roux-en-Y limb that is less than 45 cm in length. Creating a Roux-en-Y limb of adequate length essentially eliminates this problem.

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