• Increased acceptance of gastric surgery is conditional upon increasing success in avoiding postoperative recurrence of pain, especially the discomfort of the dumping syndrome.
The type of operation used must be determined partly by the preoperative nutritional status of the patient. The lean type of individuals who can hardly maintain adequate nutrition while in good health cannot tolerate wide resection of the stomach. The type of anastomosis used in the Billroth 1 operation leads to better absorption of fat and protein than does the Billroth 2.
The success of the operation is partly determined by the location and size of the stoma. Too extensive a resection leaves the patient with insufficient gastric capacity. Resection of 50% of the stomach, with vagotomy and a Billroth 1 type of anastomosis (end-to-end gastroduodenostomy), is recommended on the basis of 194 operations of this type.
Reoperation is sometimes necessary. It should include vagotomy (if that has not already been done), restoration of continuity between stomach and duodenal stump, the closure of previous anastomoses, and examination of the pancreas for possible adenomas. Attention to the postoperative diet, including semisolid foods rather than liquids during the early postoperative period, hastens the rehabilitation of the patient.