Physical Health After Total Gastrectomy

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You can expect your recovery from total gastrectomy to take many months — typically from 6 months to a year. Physical recovery from surgery (healing) alone takes 6 to 8 weeks. The first 3-6 months after total gastrectomy can also be the hardest emotionally and psychologically for the patient and their family, too. There are many physical and psychological adjustments that simply take time. 

Remember that recovery may not always feel steady; there will be both good days and bad days. You may have days where you eat more comfortably, eat more frequently and tolerate foods, fluids and vitamins well. You may also have days when eating is more difficult or your symptoms feel worse. Every patient’s experience is different. Remember to talk to your health care team if you have any concerns. 

Even if you feel that your progress one month after surgery is better than expected, at three months you may feel that recovery isn’t going fast enough and/or feel discouraged by the time it takes to recover. You may find it helpful to keep a list of milestones and the progress made after your surgery. Talk to your health care team about any concerns.  

At six months post-surgery, most patients feel as though they have “turned the corner.” This is often associated with having incorporated the new diet and lifestyle habits into your daily routines and having those habits start to feel like second nature. 

By one year post-surgery, most people feel as though they established their “new normal,” meaning the post-operative diet and lifestyle changes are now a part of their normal life.

Weight Loss

You can expect to lose weight rapidly during the first month after surgery. The rate of weight loss will eventually slow down and you may have periods when your weight is stable for days to weeks before dropping again. However, it typically takes about 6-12 months for you to reach a stable final weight. After 6-12 months, some patients can regain a few pounds over several months to years. 

Talk to your dietitian to get specific recommendations to help you avoid losing weight too quickly, to avoid losing too much weight or too much muscle mass, and to maintain a healthy weight long-term after gastrectomy. Note that it is harder to regain weight after a total gastrectomy and most patients remain well below their pre-surgery weight for the rest of their lives.  

Lifestyle Modifications

If you were very active before total gastrectomy in sports, exercise or other physical activities, or if you worked a physically demanding job, you will need to modify your activities after gastrectomy. For 8 weeks following surgery you will need to avoid heavy lifting (more than 10 pounds). It can take 6 months to a year for energy and stamina levels to return to pre-operation levels.

Lifelong, you will need to be able to eat small but frequent meals throughout the day. You will also likely need to avoid certain positions that trigger bile reflux (you can read more about bile reflux in “Diet and Nutrition Total Gastrectomy: What You Should Know”). Therefore, some people have had to adjust their work, home or school schedules, change careers/jobs or apply for special accommodations to meet their diet, nutrition and lifestyle needs after total gastrectomy. 

Bone Health

Gastrectomy increases the risk of bone density loss. Loss of bone mineral density can lead to osteopenia, osteoporosis and increases your risk of fractures. These problems can happen months to years after gastrectomy. However, the exact causes of bone density loss after gastrectomy are still unclear.

The causes of low bone density after total gastrectomy may include: 

  • Decreased absorption of calcium, which is needed for healthy bones
  • Decreased absorption of vitamin D which is needed for healthy bones
  • Weight loss after total gastrectomy, which may also impact bone health 

Because of the loss of stomach acid and the bypass of the first part of the small intestine (duodenum) after total gastrectomy, calcium from food is not absorbed well, so calcium citrate supplementation is recommended. 

The American Society for Metabolic and Bariatric Surgery (ASMBS) has guidelines for vitamin and mineral supplementation after bariatric surgery, including Roux-en-Y gastric bypass, a similar surgical procedure to gastrectomy. 

These guidelines recommend the following:

  • Take 1200-1500mg per day of elemental calcium in the form of calcium citrate
    • Calcium citrate is the form of calcium best absorbed without stomach acid
    • Take your total calcium citrate in multiple doses (up to 500 mg each) for best absorption
    • Take calcium citrate at least 2 hours apart from all oral iron supplements
  • Take at least 3,000 international units of vitamin D supplements
    • This dose can be increased to maintain a normal range of blood levels of 25-OH vitamin D (vitamin D levels can be measured from a blood test)
    • Note: Vitamin D can be included in your bariatric multivitamin You can read more about vitamins and minerals in “Diet and Nutrition After Gastrectomy: What You Should Know
    • Consider having a bone density scan (dual-energy x-ray absorptiometry, or DEXA) two years post-operatively 

To minimize the risk of bone density loss after total gastrectomy, follow these tips: 

  • Talk to your dietitian about which calcium citrate and vitamin D supplements are best for you
  • Talk to your team about exercises and physical activities to keep your bones strong
  • Talk to your team about monitoring your bone density after total gastrectomy
  • You may need medications to treat low bone density 
woman working with weights