Gastrectomy is an operation to remove part (partial gastrectomy) or all (total gastrectomy) of the stomach.
The stomach is a hollow, muscular, sac-like part of the digestive tract located between the gullet (oesophagus) and the small intestine (duodenum). It produces some enzymes and acids to facilitate the digestive process. Food is partially broken down in the stomach by churning before being released into the small bowel. However, the ability to digest food is not really affected when the stomach is removed.
The operation is usually performed in order to treat stomach cancers or complicated stomach ulcers.
A gastrectomy is performed under general anaesthesia. Most patients will be hospitalised for seven to ten days.
A vertical incision is made in the upper abdomen.
In a distal partial gastrectomy, the lower portion of the stomach is removed and the upper portion of the stomach is joined to the small intestine.
In a total gastrectomy, the entire stomach is removed and the oesophagus is attached to the small intestine. The surrounding lymph nodes are removed as well in cancer surgery.
In selected cases, the operation can be performed with small "keyhole" incisions in the abdomen. The advantages of a laparoscopic approach are:
- less postoperative pain
- early recovery of bowel function
- early hospital discharge
- early return to work
- better cosmetic results
A thin tube may be inserted through the nose into the stomach during the operation. This nasogastric tube will usually be kept in place for a few days after the operation. The patient will also have a urinary catheter.
Initially, the patient will not be allowed to eat or drink. When bowel sounds return, the diet will gradually be advanced from liquids to soft foods.
Pain medication will be given intravenously at the beginning and converted to oral form when the patient can take orally.
The patient will also be encouraged to get out of bed and walk around soon after surgery.
After discharge, the patient can perform light activity for the first 4 to 6 weeks.
The patient should also watch out for:
- Fever or chills
- Abdominal swelling
- Severe pain
- Nausea or vomiting
- Cough or shortness of breath
- Purulent drainage (pus) or from any incision
- Inability to eat or drink
Dietary adjustments are usually necessary after a gastrectomy. Such changes may include smaller, more frequent meals (up to 6 meals per day) and reduction of very sweet foods and drinks (e.g. cookies, candy, soda, and juices).
Regular injections of vitamin B12 and other vitamin/mineral supplementation may also be necessary.
Risks for any general anaesthesia include:
- Allergic reactions to medications
- Breathing problems
Risks for any major surgery include:
- Infection, in the surgical wound, lungs (pneumonia) or bladder
- Blood clots in the legs that may travel to the lungs
- Heart attack or stroke
Risks for gastrectomy include:
- Injury to the spleen, intestines, or other organs during operation
- Leakage of the contents of the stomach or intestines where they are joined together
- Narrowing of the connection between the stomach and intestine