Near-total completion gastrectomy for severe postvagotomy gastric stasis: Analysis of early and long-term results in 62 patients

The aim of this study was to evaluate results of completion gastrectomy for severe postgastrectomy gastric stasis. A total of 51 women and 11 men unde rwent completion gastrectomy for gastric stasis between 1985 and 1996; foll ow-up was complete in 98 % at 5.4 +/- 5 years. All patients had modified Vi sick scores preoperatively of grade III (37 %) or IV (63 %). Presentation i ncluded combinations of nausea, vomiting, postprandial pain, chronic abdomi nal pain, and chronic narcotic use. All had undergone prior vagotomy and ha d a median of four previous gastric operations. Hospital mortality was zero . Complications occurred in 25 patients (40 %) and included the following: narcotic withdrawal syndrome (18 %), ileus (10 %), wound infection (5 %), i ntestinal obstruction (2 %), and anastomotic leak (5 %). All or most sympto ms were relieved in 43 % (Visick grade I or II), but 57 % of the patients r emained in Visick grade III or IV. Nausea, vomiting, and postprandial pain were reduced from 93 % to 50 %, 79 % to 30 %, and 58 % to 30 %, respectivel y (P <0.05), but chronic pain, diarrhea, and dumping syndrome were not sign ificantly affected. Univariate analysis revealed no preoperative characteri stic to be predictive of good outcome. Logistic regression analysis suggest ed that the combination of nausea, need for total parenteral nutrition, and retained food in the stomach predicted a poor outcome (P <0.05). Completio n gastrectomy is successful in 43 % of patients. The combination of nausea, need for total parenteral nutrition, and retained food at endoscopy are ne gative prognostic factors.