This surgery is done in some patients who have gastroparesis or recurrent reflux after antireflux surgery. The surgery may be performed openly with a midline incision in the upper abdomen. Part or most of the stomach is removed, and the intestines are re-routed to decrease the amount of fluid that can come up into the esophagus as well as the amount of fluid that can sit in the stomach. In this way, it can help symptoms of gastroparesis and GERD that has failed all other treatments. It is a major operation with potential side effects that are life long. Dr Bell will review the risks, benefits and potential complications with you at your consultation. There are also life long nutritional consequences that you need to be aware of.
Nutritional consequences after hemigastrectomy
It is recommended that you take extra vitamins after having a hemigastrectomy:
One prenatal vitamin a day. This will start 2 weeks after surgery.
B12– This can be purchased over the counter in a form that you take under your tongue (sublingual). The recommended dose is 350 micrograms a day. You should have your B12 level checked yearly to make sure you are getting enough.
Iron– the prenatal vitamin has 40-65mg of iron which is enough for most people. Have your iron checked yearly after surgery to make sure you are getting enough. You may need to supplement more if you are not eating meat, or if you are having heavy periods.
Folate– deficiency in folate is less common with this surgery, but can happen. Usually there is enough folate in the prenatal vitamin to supplement your diet. You should have this level checked yearly.
Calcium– Calcium citrate is absorbed better than calcium carbonate. It is better if you take it with vitamin D as this helps the absorption. The recommended dose is around 1200mg for men and 1500mg for women. It is very important to continue taking calcium as there is not a blood test to see if you are getting enough as your body will take calcium from your bones to make your blood levels normal. Your doctor may check vitamin D levels, but it is difficult to assess calcium deficiencies.
While you are in the hospital, right after your hemigastrectomy, you will be started on liquids and progress to solids depending on how long you are in the hospital. Initially, you will get full faster than you did before surgery. Be careful to listen to your body and stop before you are stuffed. Small frequent meals are better tolerated right after surgery. Most patients can return to normal eating habits within a few months of surgery. There will not be any long term dietary restrictions; eat what agrees with you and avoid what does not.
Dumping syndrome- This happens to some patients after eating simple sugars (candy, sugar, etc). Shortly after eating sugar, you can get cold and sweaty, have abdominal cramps followed by diarrhea. There is nothing harmful that happens, other than feeling miserable. The best thing to do if this happens to you is to avoid simple sugars. Sometimes this improves with time, other times it is permanent.
Sometimes if you drink fluids with your meals, food can empty from your stomach too quickly which results in diarrhea. If this happens, separate your liquids from your solids and see if this helps.