ABSTRACT
Although operative procedures on the stomach are less commonly performed today than they were a decade or two ago because of the decreasing incidence of gastric cancer and the ability to manage most forms of acid-peptic disease with various pharmacologic manipulations or antibiotic regimens, gastric procedures are still performed with sufficient frequency that an understanding of those derangements that may be surgically induced is paramount to good surgical practice. Virtually any type of gastric operation is attended by some type of postoperative symptomatology; fortunately, the majority of these physiologic alterations can be managed with little patient inconvenience. Despite a surgeon’s best efforts, however, a small percentage of patients subjected to gastric surgery develop untoward sequelae that can be devastating not only to a patient’s sense ofwell-being but also to his ability to function in society and continue gainful employment. These physiologic aberrations can result from the loss of normal gastric reservoir function, transection of the vagus nerves, or interruption of normal pyloric sphincter function, or they may be directly related to the procedure performed to restore normal gastrointestinal continuity following treatment of the underlying disease. Similarly, operations on the intestine can perturb normal absorption and digestion by reducing the overall epithelial surface area involved in the digestive process as occurs during intestinal resection, or by altering its normal proximal to distal continuity as may result from various rerouting procedures. Although changes in any portion of the intestine can induce digestive malfunction, alterations in small bowel function are generally more important from the standpoint of clinical relevance.
