Observational Study
Copyright ©The Author(s) 2021.
World J Gastrointest Surg. May 27, 2021; 13(5): 461-475
Published online May 27, 2021. doi: 10.4240/wjgs.v13.i5.461
Table 1 Structure of Postgastrectomy Syndrome Assessment Scale-45
Domains
Subdomains

Items

Subscales
QOLSF-8 (QOL)1Physical functioningFive or six-point Likert scalePhysical component summary (item 1-8)
2Role physicalMental component summary (item 1-8)
3Bodily pain
4General health
5Vitality
6Social functioning
7Role emotional
8Mental health
SymptomsGSRS (Symptoms)9Abdominal painsSeven-point Likert scaleEsophageal reflux subscale (item 10, 11, 13, 24)
10HeartburnExcept item 29 and 32Abdominal pain subscale (item 9, 12, 28)
11Acid regurgitationMeal-related distress subscale (item 25-27)
12Sucking sensations in the epigastriumIndigestion subscale (item 14-17)
13Nausea and vomitingDiarrhea subscale (item 19, 20, 22)
14BorborygmusConstipation subscale (item 18, 21, 23)
15Abdominal distensionDumping subscale (item 30, 31, 33)
16nausea and vomiting
17Increased flatusTotal symptom scale (above seven subscales)
18Decreased passage of stools
19Increased passage of stools
20Loose stools
21Hard stools
22Urgent need for defecation
23Feeling of incomplete evacuation
PGSAS (Symptoms)24Bile regurgitation
25Sense of foods sticking
26Postprandial fullness
27Early satiation
28Lower abdominal pains
29Number and type of early dumping symptoms
30Early dumping general symptoms
31Early dumping abdominal symptoms
32Number and type of late dumping symptoms
33Late dumping symptoms
Living statusMeals (amount) 134Ingested amount of food per meal-
35Ingested amount of food per day
36Frequency of main meals
37Frequency of additional meals
Meals (quality)38Appetitefive-point Likert scaleQuality of ingestion subscale (item 38-40)
39Hunger feeling
40Satiety feeling
Meals (amount) 241Necessity for additional meals-
Social activity42Ability for working-
QOLDissatisfaction (QOL)43Dissatisfaction with symptomsDissatisfaction for daily life subscale (item 43-45)
44Dissatisfaction at the meal
45Dissatisfaction at working
Table 2 Patients' background
Types of gastrectomy
TGRY (n = 393)
PG (n = 193)
DGRY (n = 475)
DGBI (n = 909)
PPG (n = 313)
LR (n = 85)
Overall (n = 2368)
P value
Age (yr; mean ± SD)63.4 ± 9.2a63.7 ± 7.762.0 ± 9.161.6 ± 9.161.5 ± 8.760.8 ± 9.862.1 ± 9.1
Sex: Male/female, n (Male, %)276/113 (71)139/53 (72)318/154 (67)594/311 (66)183/126b (59)48/37 (56)1558/794 (66)0.0031
Postoperative period (mo; mean ± SD)35.0 ± 24.640.5 ± 28.131.7 ± 18.0a40.7 ± 30.7a38.4 ± 27.742.9 ± 34.237.7 ± 27.4
Approach: laparoscopic/open, n (laparoscopic, %)97b/293b (25)33b/159b (17)152/320 (32)415b/489b (46)136/173 (44)52b/33b (61)885/1467 (38)< 0.00011
Celiac branch of vagus saving/cut, n (saving, %)12b/371b (3)83b/105b (44)28b/442b (6)133b/754b (15)213b/87b (71)84b/0b (100)553/1759 (24)< 0.00011
Table 3 Comparison of main outcome measures of Postgastrectomy Syndrome Assessment Scale-45 among six types of gastrectomy using ANOM

Types of gastrectomy
TGRY (n = 393)
PG (n = 193)
DGRY (n = 475)
DGBI (n = 909)
PPG (n = 313)
LR (n = 85)
Overall (n = 2368)

DomainMain outcome measures mean ± SD mean ± SDmean ± SDmean ± SDmean ± SDmean ± SDmean ± SDN
SymptomsEsophageal reflux SS2.0 ± 1.0b2.0 ± 1.0b1.5 ± 0.7a1.7 ± 0.81.7 ± 0.81.4 ± 0.5a1.7 ± 0.94
Abdominal pain SS1.8 ± 0.81.7 ± 0.71.7 ± 0.81.7 ± 0.71.6 ± 0.71.5 ± 0.61.7 ± 0.80
Meal-related distress SS2.6 ± 1.1b2.6 ± 1.1b2.1 ± 0.9a2.1 ± 0.9a2.1 ± 0.91.5 ± 0.6a2.2 ± 1.05
Indigestion SS2.3 ± 0.9b2.2 ± 0.82.0 ± 0.82.0 ± 0.8a2.0 ± 0.91.5 ± 0.6a2.0 ± 0.93
Diarrhea SS2.3 ± 1.2b2.0 ± 1.02.1 ± 1.12.1 ± 1.11.8 ± 1.0a1.5 ± 0.8a2.1 ± 1.13
Constipation SS2.1 ± 0.92.3 ± 1.12.1 ± 1.02.2 ± 1.02.2 ± 1.11.9 ± 0.9a2.2 ± 1.01
Dumping SS2.2 ± 1.1b2.0 ± 1.02.0 ± 1.02.0 ± 1.01.8 ± 0.9a1.3 ± 0.4a2.0 ± 1.03
Total symptom score2.2 ± 0.7b2.1 ± 0.71.9 ± 0.72.0 ± 0.71.9 ± 0.71.5 ± 0.4a2.0 ± 0.72
Living statusChange in BW-13.8% ± 7.9%b-10.9% ± 8.2%b-8.4% ± 6.6%-7.9% ± 8.1a-6.9% ± 7.0%a-1.6% ± 5.7%a-8.9% ± 8.0%5
Ingestion amount of food per meal6.4 ± 1.9b6.5 ± 1.9b7.2 ± 2.07.1 ± 2.07.0 ± 1.99.0 ± 1.8a7.0 ± 2.03
Necessity for additional meals2.4 ± 0.8b2.0 ± 0.81.9 ± 0.81.9 ± 0.8a1.8 ± 0.8a1.4 ± 0.6a1.9 ± 0.84
Quality of ingestion SS3.8 ± 1.03.6 ± 1.0b3.8 ± 0.93.8 ± 0.93.8 ± 0.94.0 ± 0.8a3.8 ± 0.92
Ability for working2.0 ± 0.9b2.0 ± 0.91.8 ± 0.91.8 ± 0.9a1.8 ± 0.91.4 ± 0.6a1.8 ± 0.93
QOLDissatisfaction with symptoms2.1 ± 1.0b2.0 ± 0.91.8 ± 0.91.8 ± 0.91.8 ± 0.91.2 ± 0.4a1.8 ± 0.92
Dissatisfaction at the meal2.8 ± 1.1b2.7 ± 1.1b2.2 ± 1.1a2.2 ± 1.1a2.2 ± 1.11.3 ± 0.6a2.3 ± 1.15
Dissatisfaction at working2.1 ± 1.1b2.0 ± 1.1b1.7 ± 1.01.7 ± 0.9a1.7 ± 0.91.1 ± 0.4a1.8 ± 1.04
Dissatisfaction for daily life SS2.3 ± 0.9b2.2 ± 0.9b1.9 ± 0.91.9 ± 0.8a1.9 ± 0.81.2 ± 0.4a2.0 ± 0.94
PCS of SF-849.6 ± 5.6b49.5 ± 6.150.8 ± 5.650.5 ± 5.551.1 ± 5.352.4 ± 3.8a50.5 ± 5.62
MCS of SF-849.2 ± 6.049.0 ± 6.049.8 ± 5.749.9 ± 5.750.0 ± 6.151.6 ± 4.6a49.7 ± 5.81
Table 4 The percentage and point against overall mean of the main outcome measures of Postgastrectomy Syndrome Assessment Scale-45 among six types of gastrectomy

Types of gastrectomy
TGRY

PG

DGRY

DGBI

PPG

LR

Overall
DomainMain outcome measures%aPointb%aPointb%aPointb%aPointb%aPointb%aPointb%a
SymptomsEsophageal reflux SS115.5-3116.4-386.6299.1099.1079.64100
Abdominal pain SS105.0-199.5098.90100.5097.7087.62100
Meal-related distress SS120.8-4120.2-495.2093.7196.3067.36100
Indigestion SS112.0-2105.5-199.8097.0098.0072.55100
Diarrhea SS110.4-294.9199.90102.8089.3273.65100
Constipation SS96.20105.9-197.20102.20103.0085.62100
Dumping SS116.3-3103.3099.5099.4088.6264.27100
Total symptom score111.0-2105.8-197.2099.4095.6074.45100
Living statusChange in BW153.1-10121.8-499.4088.2276.6418.116100
Ingestion amount of food per meal91.4-192.2-1102.90101.3099.80127.65100
Necessity for additional meals121.6-4105.3-198.3096.3090.7173.35100
Quality of ingestion SS99.8094.7-199.80100.7099.80107.11100
Ability for working112.3-2107.5-1100.5096.2097.2077.44100
QOLDissatisfaction with symptoms112.7-2108.8-197.8098.1097.2064.97100
Dissatisfaction at the meal122.2-4116.6-394.6195.0196.9054.79100
Dissatisfaction at working121.1-4115.2-397.2094.7194.2162.57100
Dissatisfaction for daily life SS118.9-3113.6-296.4095.9096.1060.27100
PCS of SF-898.3098.10100.60100.10101.10103.90100
MCS of SF-898.8098.50100.20100.20100.50103.60100
QOL score (Total point)-47-26351097