Stoma Dysfunction After Total Gastrectomy: Causes and Solutions

Q: Stoma Dysfunction After Total Gastrectomy: Causes and Solutions

Hello： Jejunum? Failure? Redo? Stoma function? What type of stoma?

Fistula surgery

In October 2019, I went to the emergency department at Chung Cheng Hospital due to intestinal obstruction.
As a result, I underwent a stoma procedure, which revealed that stomach cancer had metastasized to the colon.
However, about six months later, my attending physician recommended a total gastrectomy to see if the tumor could be completely removed through surgery.
Naively, I thought this was the beginning of a positive outcome, but things turned out differently.
The total gastrectomy led to my admission to the intensive care unit for over three weeks, and my wound healed very slowly.
After being discharged on June 18, 2020, I discovered that I was experiencing severe vomiting when trying to eat.
It felt like whatever I consumed would come back up.
The function of the stoma diminished, and I had to return to the hospital for TPN (total parenteral nutrition).
The response from Chung Cheng Hospital was unacceptable...
There were clearly other treatment options available to help manage the functional changes caused by the total gastrectomy.
I have now transferred to another hospital and would like to ask Dr.
Yu about the reasons for the stoma dysfunction, which is preventing the metabolism of food and liquids.
Currently, I can only wait for the director of the new hospital to perform surgery.
They have already attempted surgery once and mentioned that the gastrointestinal tract is fibrotic and cannot be operated on.
Can I ask Dr.
Yu about this?

Ddlan, 30~39 year old female. Ask Date: 2021/03/14

Dr. Yu Mingchang reply Surgery

Hello: Jejunum? Failure? Redo? Stoma function? What type of stoma?

Reply Date: 2021/03/14

More Info

Understanding stoma dysfunction after a total gastrectomy is crucial for managing the complications that can arise from this significant surgical procedure. A total gastrectomy involves the complete removal of the stomach, which can lead to various physiological changes and complications, including stoma dysfunction.
In your case, it appears that following the total gastrectomy, you have experienced severe vomiting and a decrease in the functionality of your stoma. This can be attributed to several factors:
1. Anatomical Changes: After a total gastrectomy, the normal anatomy of the gastrointestinal tract is altered. The food that would typically pass through the stomach is now directly routed into the small intestine. This can lead to rapid gastric emptying, also known as dumping syndrome, which can cause nausea and vomiting shortly after eating.

2. Stoma Functionality: The stoma, which is an opening created surgically to allow waste to exit the body, may not function optimally due to changes in bowel motility or scarring from the surgery. If the stoma is not functioning properly, it can lead to complications such as obstruction or inadequate waste elimination, which may contribute to your symptoms.

3. Nutritional Absorption: With the stomach removed, the body may struggle to absorb nutrients effectively. This can lead to malnutrition and the need for total parenteral nutrition (TPN), as you mentioned. TPN is a method of feeding that bypasses the gastrointestinal tract, providing nutrients directly into the bloodstream.

4. Fibrosis and Adhesions: Post-surgical complications such as fibrosis (thickening and scarring of connective tissue) and adhesions (bands of scar tissue that can form between organs) can lead to bowel obstruction or impaired motility. If your healthcare provider has indicated that there is fibrosis in the gastrointestinal tract, this could explain the difficulties you are experiencing.

5. Psychological Factors: The psychological impact of undergoing major surgery and dealing with ongoing health issues can also affect gastrointestinal function. Stress and anxiety can exacerbate symptoms like nausea and vomiting.

To address these issues, several strategies may be considered:
- Nutritional Support: Working with a dietitian who specializes in post-gastrectomy care can help you develop a nutrition plan that meets your needs while minimizing symptoms. This may include small, frequent meals that are easier to digest.

- Medication Management: Medications to manage nausea, vomiting, and gastrointestinal motility may be prescribed. Discussing these options with your healthcare provider can help tailor a regimen that works for you.

- Stoma Care: If the stoma is not functioning properly, consulting with a stoma care nurse can provide insights into proper care and management techniques that may improve its functionality.

- Surgical Intervention: If conservative measures do not alleviate your symptoms, further surgical evaluation may be necessary. This could involve addressing any adhesions or fibrotic changes that are contributing to your symptoms.

- Regular Follow-Up: Continuous follow-up with your healthcare team is essential to monitor your condition and make necessary adjustments to your treatment plan.

In summary, stoma dysfunction after a total gastrectomy can arise from a combination of anatomical changes, nutritional absorption issues, and potential complications such as fibrosis and adhesions. A multidisciplinary approach involving dietary management, medication, and possibly surgical intervention is essential for optimizing your health and quality of life post-surgery. It is important to maintain open communication with your healthcare providers to ensure that all aspects of your care are addressed.

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