Postoperative Care after Gastrectomy

After gastrectomy surgery, most patients are taken to the postanesthesia care unit (PACU) and are closely monitored by the nursing staff until the anesthesia wears off. They may spend several hours in the PACU, depending on how quickly they recover from the surgery. When they are stable, they are transferred to their room.

Some patients need closer monitoring and attention. Those who are having respiratory problems, those who were very ill prior to the operation, and those who developed complications during the procedure are taken to the surgical intensive care unit until they are stable enough to be transferred to their hospital room.

Upon waking from anesthesia, patients have an intravenous line, a urinary catheter, and a nasogastric tube. They are not allowed to eat or drink immediately following surgery. Oxygen may also be delivered through a plastic mask that fits over the mouth and nose, or through nasal prongs. Patients experience pain from the incision and medication is prescribed to provide relief. Pain medication is usually delivered intravenously.

Intensive care patients are connected to a monitor that measures their heart rate and breathing. Their blood pressure and blood oxygen level are continuously monitored. Some patients require a respirator to breathe for them, and additional intravenous lines to deliver medication and fluids.

Recovery is a gradual process. The nasogastric tube is attached to intermittant suction to keep the stomach empty. If the entire stomach has been removed, the tube goes directly to the small intestine and remains in place until bowel function returns. This generally takes between 2 and 3 days and is determined by listening to the abdomen with a stethoscope for bowel sounds (the passage of gas). A bowel movement also indicates healing.

When bowel sounds return, clear liquids are offered. If they are tolerated, the nasogastric tube is removed and the diet is gradually advanced from liquids to soft foods, and then to more solid foods. Dietary adjustments may be necessary, as certain foods may now be difficult to digest.

The urinary catheter is removed in a day or two, depending on recovery. When food and liquid are tolerated, and urine output is normal, the catheter is removed. The intravenous may also be removed, but it remains in longer if medications, such as antibiotics and painkillers, have been prescribed.

The day after surgery, most patients can get out of bed. Getting up and moving around is one of the best ways to prevent postoperative complications. Movement helps blood circulation return to normal, decreases the risk for a blood clot, helps bowel function normalize, and lowers the risk for lung infection. Getting out of bed can be painful and puts pressure on the incision. Pain medication is prescribed and can be given before the patient attempts to get up.

Diet may present a challenge, especially for those whose entire stomach was removed. Food and liquids now enter the small intestine quickly, causing uncomfortable symptoms that can usually be relieved by eating several small meals, eating more protein and less sugar, and making other dietary changes. A nutritionist or dietician can help develop new eating habits. The dietary changes may be temporary, until the digestive system adjusts, or they may be permanent.

Vitamin B12 is absorbed in the stomach and must be supplemented with regular injections by patients who underwent a total gastrectomy. Absorption may be impaired in those who still have part of their stomach, so it is necessary to have B12 levels checked periodically. Supplementation with folate, iron, and calcium may also be necessary to correct deficiencies caused by the surgery.

The length of hospitalization varies. Full recovery may take several weeks or a few months, especially if the patient has gastrointestinal problems such as diarrhea, which can be debilitating. Recovery may also be prolonged by other treatments, such as chemotherapy.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 01 Nov 2001

Last Modified: 21 Dec 2011