GASTRECTOMY FOR COMPLICATIONS OF BARIATRIC PROCEDURES

Background: Major complications of modern bariatric operations are inf requent but can be quite disabling to the patient and pose therapeutic challenges to the surgeon. We present our experience with five patien ts who underwent gastrectomy for complications following gastric reduc tion procedures. Patients and Methods: Between 1991 and 1995, four wom en and one man, average age 46.8 years (34-66), underwent total gastre ctomy and Roux-en-Y end-to-side esophagojejunostomy (4), or near-total gastrectomy with esophagogastrostomy (1), The decision to perform tot al gastrectomy was based on the poor quality of the remaining gastric pouch and the surgeon's judgment. Preoperative diagnoses included gast ric outlet obstruction secondary to anastomotic ulcer or stricture, ga stroesophageal reflux with esophagitis, chronic gastrocutaneous fistul a, and iatrogenic linitis secondary to gastric wrap with mesh. Preoper atively, the patients complained of intolerable nausea, vomiting, abdo minal pain, and dysphagia. Results: In the five patients who underwent total or near-total gastrectomy, there was no operative mortality or morbidity; however, one patient (near-total gastrectomy) has required a second operation for pyloroplasty, Although one patient was lost to follow-up 6 months after surgery, the average follow-up for the remain ing four patients is 2 years. These four patients were interviewed and all report complete satisfaction with their surgery and much improvem ent in their symptoms. Presently, they consume an average of three mea ls per day (range 2-6), with each meal measuring about 2 cups in size. All report the sensation of satiety after meals. All patients receive supplemental iron, B-12, and multivitamins. From a nutritional standp oint, there has not been a significant change in the levels of albumin , total protein, hematocrit, weight and BMI since total gastrectomy. C onclusions: In our experience, total gastrectomy with Roux-en-Y end-to -side esophagojejunostomy is an appropriate therapy with low morbidity and mortality in highly selected patients with complications resultin g from gastric reduction procedures.