Gastrectomy

Overview

A gastrectomy is a surgical procedure that entails the removal of all or part of the stomach. The stomach functions as a reservoir for food in the digestive system, aiding in storage and the initial breakdown before nutrients are absorbed in the small intestine. In cases of conditions like stomach (gastric) cancer, requiring medical intervention, a gastrectomy may be carried out to prevent potential harm. Despite the modification to the digestive system, individuals can still lead a life without a stomach, adjusting their eating habits accordingly.

Types

Gastrectomies come in two types:

• Total gastrectomy involves the complete removal of your stomach.
• Partial gastrectomy includes various surgical procedures that eliminate a part of your stomach. The specific names of these procedures vary depending on the extent of stomach tissue removal. In some types, a subtotal gastrectomy removes approximately 80% of the stomach. Some procedures are categorized based on their intended purpose, such as gastric sleeve surgery, which is a partial gastrectomy designed to address severe (Class III) obesity.

Reasons for undergoing the procedure

Gastrectomy is a surgical procedure commonly utilized in the management of stomach cancer. Its purpose can range from eliminating or preventing the spread of cancer to providing palliative relief for symptoms like stomach bleeding and pain.

Apart from its primary role in cancer treatment, gastrectomy serves as a last-resort option for certain conditions when other interventions prove ineffective. This surgical approach is applicable to various medical issues, including:

• Benign stomach tumors: Tumors displaying symptoms or having the potential to become cancerous may necessitate surgical removal.
• Peptic ulcer disease: Surgery may be recommended to address stomach sores and ulcers threatening the stomach lining.
• Gastritis: In rare instances, severe inflammation of the stomach lining causing persistent symptoms may require surgery when medication falls short.
• Injuries: Removal of portions of the stomach may be necessary when an injury has irreparably damaged the tissue.
• Obesity: Partial gastrectomy may be suggested as a form of bariatric (weight loss) surgery when obesity poses a risk to overall health.

For individuals at high risk of hereditary diffuse stomach cancer due to inheriting a mutation in the CDH1 gene, opting for total gastrectomy might be a preventive measure. This specific cancer is challenging to detect in its early stages when treatments are most effective. In such cases, healthcare providers may recommend the complete removal of the stomach.

Risks

Surgery, like any medical procedure, carries inherent risks such as infection, anesthesia allergies, and blood clots. Following the surgery, the use of compression socks may be recommended to minimize the risk of clot formation.

Specific complications associated with gastrectomy include:

• Bile reflux: This happens when bile, produced by the liver for fat digestion, flows backward into the stomach or esophagus, potentially breaking down the protective lining.
• Malnutrition: Many individuals experience a weight loss of around 10% in the initial months after surgery, leading to a deficiency in essential nutrients and conditions like anemia.
• Afferent and efferent loop (limb) syndrome: This occurs when digestive juices become trapped in the small intestine, leading to symptoms like abdominal pain, nausea, and vomiting.
• Dumping syndrome: This occurs when food reaches the small intestine before adequate breakdown, resulting in unpleasant symptoms like nausea, bloating, pain, and diarrhea.
• Post-surgery gastroparesis: Delayed processing of food in the stomach, leading to symptoms such as bloating, nausea, vomiting, and indigestion.
• Internal hernia: Parts of the small intestine may protrude through the membrane connecting the intestine to the abdominal wall, causing abdominal pressure or pain and necessitating emergency treatment.
• Narrowing at the attachment site: This refers to the constriction of the connection between the partial stomach or esophagus and small intestine, potentially causing bowel obstruction and difficulties with bowel movements.
• Anastomotic leak: A situation where there is a leakage at the new attachment sites.

It is crucial to communicate any complications to your healthcare provider and attend all follow-up appointments to ensure proper healing without complications.

Before the procedure

Preparation for a stomach surgery

• Medical history review: Ensure a thorough review of your medical history with your healthcare provider, covering discussions on medications, vitamins, herbs, and supplements, as well as allergies and past responses to anesthesia. this comprehensive assessment is crucial for determining your suitability for surgery and ensuring a safe and tailored approach to your medical care.
• Diet and exercise modification: Adjust your diet and exercise regimen based on your provider’s recommendations to optimize your physical condition for surgery.
• Tobacco cessation: Quit smoking or chewing tobacco several weeks before surgery for improved surgical outcomes, especially for stomach cancer patients.
• Medication adjustment: Temporarily stop medications that can thin your blood, such as nsaids, aspirin, and warfarin, under the guidance of your healthcare provider.
• Fasting instructions: Follow fasting instructions provided by your healthcare provider, including restrictions on eating and drinking before surgery.
• Transportation arrangements: Coordinate with someone to drive you home from the hospital after the surgery.
• Home preparation: Prepare your home for post-surgery recovery by relocating essential items within easy reach, minimizing the need for heavy lifting. additionally, it is advisable to consider arranging for someone to stay with you during the recovery period to provide support and assistance as needed, promoting a smoother and more comfortable healing process.
• Live-in assistance: Consult your healthcare provider about potential live-in assistance needs and the duration required for a smooth recovery process.

During the procedure

Surgery involving the removal or partial removal of your stomach is a complex procedure aimed at addressing specific medical conditions. the process involves several key steps, ensuring your well-being throughout the operation:

• Administration of anesthesia: You will receive anesthesia through an intravenous (IV) line, inducing a state of unconsciousness for the duration of the surgery. this ensures you feel no pain and remain unaware of the procedure.
• Placement of necessary catheters: Catheters may be inserted as needed, including a bladder catheter to collect urine and a nasogastric tube through your nose into your stomach for suctioning stomach contents. additionally, the nasogastric tube may be utilized for medication and nutrient administration.
• Stomach removal: The actual removal of all or part of your stomach is conducted through either open surgery or laparoscopy. in open surgery, a single large incision is made, whereas laparoscopy involves smaller incisions and the use of a camera-equipped instrument (laparoscope) to visualize and perform the surgery.
• Reconstruction of the digestive system: Following stomach removal, your surgeon reconstructs the digestive system by connecting the remaining organs. for instance, if a portion of the stomach is removed, the small intestine is attached to the remaining stomach parts. in cases of complete stomach removal, the small intestine may be connected to the esophagus. a feeding tube may be inserted directly into the stomach or small intestine to facilitate eating during recovery.
• Suturing: The incisions made during surgery are carefully stitched to promote healing.

The entire procedure may take up to five hours, with the duration influenced by the type of gastrectomy and whether it is performed through open surgery or laparoscopy. due to its complexity, this surgery requires meticulous attention and expertise from your healthcare team to ensure a successful outcome and your well-being throughout the recovery process.

After the procedure

After the surgery, your hospital stay will extend for up to two weeks to facilitate close monitoring by your healthcare team. During this period, they will focus on ensuring proper nutrition intake and gradually introducing solid foods into your diet. Pain management will be a priority, with the team monitoring your pain levels and administering medications as necessary.

While individual experiences may vary, the recovery process typically follows several phases during your hospital stay:

• Initial nutrition support: Initially, nutrition will be administered through an IV or a catheter in your belly to support your healing wound.
• Liquid diet progression: Subsequently, you will transition to a liquid diet that you can take by mouth. Prior tests may be conducted to verify the proper functioning of your digestive system.
• Advancement to soft diet: Progressing further, you will move on to a soft diet and gradually transition to lighter meals, aligning with your recovery progress.

Throughout this process, your care team will offer guidance on wound care. Specific instructions may include opting for sponge baths instead of baths or showers until your wound achieves complete healing. Recognizing that each individual’s recovery journey is unique, your healthcare providers will tailor their approach to address your specific needs and ensure a smooth recuperation during your hospital stay.

Outcome

Gastrectomy is a major surgery with a recovery period of up to two months. Adjusting to new eating habits and regaining energy may take three to six months. Driving safely may be possible after a month. Return to work depends on the job type, with remote work or part-time options considered. Living without a stomach is possible, but dietary adjustments are necessary. Tips for post-surgery include getting adequate rest, consuming smaller, more frequent meals, adjusting food choices, taking necessary vitamins and supplements, and gradually incorporating light exercise. Regular follow-up appointments with healthcare providers are crucial, and any new or worsening symptoms should be reported promptly, including nausea, diarrhea, abdominal pain, or signs of infection at the surgical site.