Gastrectomy Definition

A gastrectomy is a surgical procedure in which part or all of the stomach is removed. Gastrectomies are usually performed to treat stomach cancer, but they may be used to treat bleeding gastric ulcers, holes in the stomach wall or benign polyps. Gastrectomies are performed in conjunction with a Billroth I or Billroth II procedure, which makes the necessary attachments among the esophagus, the remaining portion of the stomach, and the small intestines. It is possible to live with a partial stomach or without any stomach. A partial stomach still functions, and the small intestines are responsible for most nutrient absorption.

History

• The first successful gastrectomy was performed in 1881 by Austrian surgeon Christian Albert Theodor Billroth. Considered the founder of modern abdominal surgery, Billroth used a gastrectomy to treat stomach cancer. Before peptic ulcers in the gastrointestinal tract were treated with antibiotics (as they have been since they were tied to Helicobacter pylori bacteria), gastrectomies were used as a treatment. Historically, gastrectomies were often accompanied by vagotomies, the removal or severing of the vagus nerve, to stem acid production. Today, this is accomplished with proton pump inhibitors.

Procedure

• A gastrectomy typically takes one to three hours. The surgery is performed under general anesthesia. The surgeon makes an incision from below the breastbone down to the navel. Clamps are used to seal off necessary parts (like the intestines, depending on which part of the stomach is being removed). The stomach is then cut out. When cancer has necessitated the gastrectomy, lymph nodes and the spleen may be removed as well.

Pre-Op

• Before the operation, patients will typically be asked to eat a high-fiber diet for a few days and to drink plenty of water to help cleanse the stomach, intestines and bowels. A laxative and an enema the day before the operation are also useful. The patient will be instructed not to eat or drink for a specified period leading up to the surgery. Certain medications may need to be stopped for a specified period beforehand, possibly including blood thinners, blood pressure medications and insulin.

Post-Op

• Gastrectomy recovery time varies, depending largely on a patient's condition before surgery. Patients remain hooked up to a catheter and nasogastric tube, and possibly an oxygen mask, for up to three days. They receive antibiotics and pain and anti-nausea medications intravenously as needed. Patients can't eat or drink immediately, but eventually the doctor will monitor fluid intake and urinary output. Once the doctor hears bowel noises with a stethoscope, patients can eat. They can typically walk around the next day.

Ongoing Care

• The doctor will provide instructions to keep the surgical stitching clean and secure. Dietary changes and restrictions will be needed. Frequent, small meals that are high in protein and low in sugar and carbohydrates are often prescribed. Certain nutritional supplements may be needed, including calcium, iron and folate. Injections of a vitamin B12 supplement will be necessary following removal of the entire stomach.

Potential Complications

• As with any surgery, gastrectomies have possible complications. The most common is "dumping syndrome," when food passes into the intestines too quickly. Symptoms include nausea, vomiting, cramping, diarrhea, dizziness, trouble breathing and excessive perspiration. The condition generally resolves itself as the body adjusts, and dietary changes can alleviate the symptoms. Other complications can include infections, internal bleeding, peritonitis (inflamed membranes on the abdominal wall), pernicious anemia (from vitamin B12 deficiency), other nutritional deficiencies and digestive problems.