Gastrectomy: Long-Term Care

The removal of part or all of the stomach is called a gastrectomy. A gastrectomy is done for various reasons, including to treat stomach cancer, peptic ulcers, or for obesity.

People can go on to live a normal life after having a partial or total gastrectomy, although it is important to pay close attention to nutrition and ensure that all the necessary vitamins and minerals are gotten through diet or supplements.

There will be a need for ongoing medical care after having a gastrectomy, although how often it will be necessary to see a physician and have, for instance, bloodwork to monitor vitamin levels, will be highly individualized.

Woman chopping greens at a center island in a kitchen.
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Benefits of Surgery

Gastrectomy surgery will result in lifestyle changes but this surgery can improve quality of life and is life-saving in some cases.

For that reason, it's important to follow the instructions from the surgical team and other healthcare professionals, such as a dietitian or physical therapist. This will ensure a quicker recovery from surgery and a return to normal activities and diet as soon as possible.

Maintaining a healthy weight is an important part of long-term recovery and following a diet plan that's compatible with gastrectomy surgery will help in achieving that goal.

It may take time to develop a fitness and diet plan that prevents muscle loss, sustains vitamin and mineral levels, and supports an optimal weight. With the help of health care professionals, the benefits of having gastrectomy surgery can be preserved.

Possible Future Complications

There are some potential complications that might occur after gastrectomy surgery. The risk of these complications will vary widely based on the reason for the surgery as well as the amount of stomach removed and if the surgery was more extensive, such as if lymph nodes were removed.

Dumping Syndrome

Dumping syndrome is a common complication after certain types of gastric surgery, such as a gastrectomy. However, it often goes undiagnosed for some time, and therefore untreated. The symptoms of dumping syndrome can include:

Symptoms of dumping syndrome may occur between one and three hours after eating and can have a negative effect on quality of life. There are several measures that are used to treat dumping syndrome. Most of them include making changes to the diet. Some potential treatments include:

  • Not drinking fluids until half an hour after eating
  • Lowering the amount of carbohydrates in the diet
  • Increasing the amount of fiber and protein eaten
  • Lying down after eating
  • Adding supplements that slow gastric emptying (in some cases)

Anemia

Deficiencies in vitamin B12 and iron may lead to anemia. Anemia is a lack of healthy red blood cells. The symptoms of anemia can include feeling tired, trouble concentrating, and feeling lightheaded or dizzy.

It may be recommended that regular blood testing be done to monitor blood levels as well as iron and vitamin B12 levels. Supplementing the needed vitamins and minerals might be needed if anemia becomes a problem.

Bone Loss

Related to vitamin deficiencies, bone loss is common after gastrectomy to treat cancer. After having a gastrectomy, some people may experience a vitamin D deficiency. This might lead to bone loss, which in turn is a cause in the development of osteopenia and/or osteoporosis.

Increasing vitamin D and calcium through diet and potentially through supplementation may be important in preventing bone loss.

Vitamin Deficiencies

In some cases, it may be difficult to get enough of certain vitamins and minerals after having gastrectomy surgery. However, which vitamins might require supplementation will be individualized based on a number of factors, including the diagnosis for which the surgery was needed and the role of diet.

Regular vitamin level testing might be recommended by the healthcare team. When it's known that there is a lack of certain vitamins, supplementation might be recommended.

Lifestyle Adjustments

Having part or all of one's stomach removed means that there is a need to pay close attention to diet and nutrition. The stomach is where some digestion takes place and certain vitamins and minerals are absorbed.

While the part of the stomach and/or the digestive system that remains after surgery will start to take over some of the absorption that the stomach used to do, that will take time.

It will be necessary to ensure that enough calories, vitamins, and minerals are being taken in each day to maintain a healthy weight. Many people lose a significant amount of weight after having gastrectomy surgery to treat cancer.

There are several ways that people can change how they eat in order to help make sure that they're receiving the vitamins and minerals they need. The changes may represent a different way of interacting with food than how most people are used to eating prior to having surgery.

For those who need to maintain their weight, or gain weight, changing the content of their meals may help.

Have quality food available. It might not be possible to go several hours without eating, so when away from home, it will be important to plan ahead. Taking along some quality, high calorie snacks when leaving the house will be an important part of keeping up with calorie and nutrient needs.

Eat small, frequent meals. After gastrectomy surgery, many people will feel full after even a small meal. That's why it might help to eat several smaller meals throughout the day, instead of three big ones. To some, this might feel like they're eating all day, but aiming to have a meal or a snack every two or three hours should be the goal.

Calorie density is important. When thinking about and planning meals for the day or the week, consider the calories in every meal. Balancing out calories during the day and making sure that one is receiving enough at each meal will be important.

Keeping track of foods and meals with an app or even in a written journal can help. This is also helpful when meeting with the healthcare team. Most people don't remember what they've eaten over a series of days or weeks, and

Drink calories. Choosing beverages that are nutrient and calorie dense can help in meeting daily needs. Drinking milk or milk substitutes, juice, or a smoothie can help in meeting the goals of having enough liquids during the day while also adding some calories and vitamins.

Vary the types of food. In the beginning, the surgeon or dietitian may give instructions on which foods to eat or avoid. Over time, that list can be expanded and more foods can be added back into the diet.

It's a good opportunity to assess diet overall and to ensure that as well as receiving enough calories, that there are a variety of fruits and vegetables as well.

A Word From Verywell

Many people go back to eating a varied diet after gastrectomy surgery. It's going to be important to keep up with regular doctor visits in order to stay on top of any potential complications. Vitamin and mineral deficiencies can lead to a wide variety of difficulties and other conditions (including anemia and osteopenia).

However, some problems may be preventable through careful tracking of nutrients in the diet. Others might be prevented through supplementation that is done under the supervision of a physician and/or a dietitian.

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  3. Oh HJ, Yoon BH, Ha YC, Suh DC, Lee SM, Koo KH, Lee YK. The change of bone mineral density and bone metabolism after gastrectomy for gastric cancer: a meta-analysis. Osteoporos Int. 2020;31:267-275. doi:10.1007/s00198-019-05220-2. 

  4. Rino Y, Oshima T, Yoshikawa T. Changes in fat-soluble vitamin levels after gastrectomy for gastric cancer. Surg Today. 2017;47:145-150. doi:10.1007/s00595-016-1341-5. 

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