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Nutritional Management With a Gastrectomy

A gastrectomy or stomach resection is a surgical procedure in which the stomach is removed. When all of the stomach is removed it is called a total gastrectomy. When part of the stomach is removed, it is called a partial or subtotal gastrectomy. Proper nutrition plays an important role after surgery.

  1. Reasons for a Gastrectomy

    • Most stomach cancers are treated with resection. Surgery for peptic ulcer disease occurs less frequently than it used to, but may be necessary when medical management has not worked. Perforation, hemorrhage or obstruction are a few complications of peptic ulcer disease that can lead to resection.

    Stomach Function

    • In the stomach, food is mixed with digestive juices and enzymes before being released into the small intestine in the form of chyme. When stomach resections occur, it is important to find out how much and which area of the stomach was removed to adjust the nutrition plan accordingly. Depending on the type of surgery, a pouch can be created, acid can be re-routed, or enzyme supplements may be necessary to aid digestion. Most digestion and absorption occurs in the small intestine, so it is possible to maintain adequate nutrition status without a complete stomach.

    Nutritional Status Impact

    • As there are many types of stomach surgeries, it is important to find out which was performed in case enzymes or extra vitamins are needed. Hydrochloric acid and intrinsic factor, produced in the stomach, are involved in iron and vitamin B12 absorption so someone who undergoes a total gastrectomy will likely need intramuscular vitamin B12 injections to maintain adequate stores.

    Diet Advancement After Surgery

    • Clear liquids followed by soft, low-fiber foods are usually tolerated well after surgery. High-sugar, fatty, spicy and high-lactose foods may cause discomfort. Small, frequent meals usually fair better than large meals. The diet should be advanced to regular as tolerated, adding one food at a time. Vitamins or nutrition supplements may be necessary to prevent deficiencies and to maintain weight status. Anemia and metabolic bone disease are common so iron, vitamin B12, folic acid, calcium, and vitamin D are usually supplemented.

    Dumping Syndrome

    • After a gastrectomy, gastric emptying and normal responses to a meal are altered. A potential complication is dumping syndrome, where food is moved too fast into the small intestine. Nausea, sweating, diarrhea, weakness and blood-sugar changes are some of the common symptoms. To avoid dumping syndrome, low- or no-added-sugar foods are preferred; drink liquids between meals (not with), and lying down after meals can help.

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