Gastrectomy

(Diagram of the stomach, showing the different regions.)

A gastrectomy is a partial or full surgical removal of the stomach.

Indications

Gastrectomies are performed to treat cancer and perforations of the stomach wall.

In severe duodenal ulcers it may be necessary to remove the lower portion of the stomach called
the pylorus and the upper portion of the small intestine called the duodenum. If there is a
sufficient portion of the upper duodenum remaining a Billroth I procedure is performed, where
the remaining portion of the stomach is reattached to the duodenum before the bile duct and the
duct of the pancreas. If the stomach cannot be reattached to the duodenum a Billroth II is
performed, where the remaining portion of the duodenum is sealed off, a hole is cut into the next
section of the small intestine called the jejunum and the stomach is reattached at this hole. As the
pylorus is used to grind food and slowly release the food into the small intestine, removal of the
pylorus can cause food to move into the small intestine faster than normal, leading to gastric
dumping syndrome.
Polya's operation

A type of posterior gastroenterostomy which is a modification of the Billroth II operation.

Resection of 2/3 of the stomach with blind closure of the duodenal stump and retrocolic
anastomosis of the full circumference of the open stomach to jejunum

Post-operative effects

The most obvious effect of the removal of the stomach is the loss of a storage place for food
while it is being digested. Since only a small amount of food can be allowed into the small
intestine at a time, the patient will have to eat small amounts of food regularly in order to prevent
gastric dumping syndrome.

Another major effect is the loss of the intrinsic factor secreting parietal cells in the stomach
lining. Intrinsic factor is essential for the uptake of vitamin B12 and without it the patient will
suffer from a vitamin B12 deficiency. This can lead to a type of anemia known as pernicious
anemia which severely reduces red-blood cell synthesis (known as erythropoiesis). This can be
treated by giving the patient direct injections of vitamin B12.

History

The first successful gastrectomy was performed by Theodor Billroth in 1881 for cancer of the
stomach.

Historically, gastrectomies were used to treat peptic ulcers.[1] These are now usually treated with
antibiotics, as it was recognized that they are usually due to Helicobacter pylori.

In the past a gastrectomy for peptic ulcer disease was often accompanied by a vagotomy, to
reduce acid production. Nowadays, this problem is managed with proton pump inhibitors.