What is a correct statement regarding complications of gastrectomy?

Complications of Gastrectomy: Correct Statement Analysis

Diarrhea is a sign of vagal nerve injury following gastrectomy, making option D the correct statement among the choices provided.

Analysis of Each Option

A) Duodenal blow-out after Billroth II

This statement is incorrect. Duodenal blow-out (duodenal stump leakage) is indeed a potential complication after Billroth II gastrectomy, but it occurs due to technical errors or poor surgical technique rather than "bad choice of operation" 1. The proper management of the duodenal stump during Billroth II reconstruction is critical to prevent this serious complication.

B) Missing criminal nerve not causing recurrent ulceration

This statement is incorrect. The "criminal nerve" refers to a branch of the posterior vagal trunk that may be missed during vagotomy. When this nerve is missed during the procedure, it can continue to stimulate acid secretion, which may lead to recurrent ulceration after gastrectomy.

C) Dumping syndrome due to hypo-osmolar solution

This statement is incorrect. Dumping syndrome occurs when hyperosmolar (not hypo-osmolar) food contents rapidly enter the small intestine after gastrectomy. This rapid emptying of hyperosmolar contents causes fluid shifts, hormonal responses, and symptoms including dizziness, flushing, and palpitations.

D) Diarrhea as a sign of vagal nerve injury

This statement is correct. Vagal nerve injury during gastrectomy can lead to diarrhea as part of postvagotomy syndrome 1. When the vagus nerve is damaged or severed during gastric surgery, it disrupts normal gastrointestinal motility and secretion patterns, which can result in diarrhea. This is a recognized complication of gastrectomy procedures.

E) Postgastrectomy nutritional disturbances include vitamin E deficiency

This statement is incorrect. While nutritional deficiencies are common after gastrectomy, vitamin E deficiency is not typically highlighted as a primary concern. According to guidelines, the most common nutritional deficiencies after gastrectomy include vitamin B12, iron, calcium, and vitamin D 1. These deficiencies can lead to conditions such as anemia and osteoporosis, which are well-documented postgastrectomy complications.

Key Complications of Gastrectomy

1. Nutritional Complications:

   • Vitamin B12 deficiency (requires supplementation)
   • Iron deficiency anemia
   • Calcium and vitamin D deficiency leading to bone disease
   • The incidence of osteoporosis may be as high as 32-42% after gastrectomy 1

2. Functional Complications:

   • Dumping syndrome (early and late)
   • Diarrhea due to vagal nerve injury
   • Postprandial abdominal fullness (common after Billroth II)
   • Weight loss, especially in the first three months

3. Surgical Complications:

   • Anastomotic leaks (though infrequent at 1.9%, they are life-threatening) 2
   • Bleeding
   • Strictures at anastomotic sites
   • Internal hernias after procedures like RYGB 1

Clinical Pearls

• Postgastrectomy patients should be monitored for bone disease, especially those who are at least 10 years postgastrectomy 1
• Endoscopy is the first recommended diagnostic tool for patients presenting with gastrointestinal bleeding after gastric surgery 1
• Dumping syndrome typically improves within one year after surgery 2
• Postprandial abdominal fullness is a common complaint that may persist for several years after Billroth II reconstruction 2

Understanding these complications is essential for proper management of patients who have undergone gastrectomy, allowing for early intervention and improved quality of life.