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Gastrectomy What is a gastrectomy and why is it necessary? A gastrectomy is the surgical removal of all or part of the stomach.

It is performed as treatment for stomach cancer, noncancerous polyps, gastric ulcers or a hole (perforation) in the stomach wall. The stomach is the digestive organ that is connected between the esophagus and the small intestine. Food enters the stomach through the esophagus where it is broken down and then transferred to the small intestine where the nutrients are absorbed. If a partial gastrectomy is performed, only a portion of the stomach is removed. If the entire stomach is removed, the esophagus will be connected directly to the small intestine. Dietary changes may be necessary to help the body adapt to changes in the digestive tract. Details of the procedure What do I need to do before surgery? Please contact your insurance company to verify coverage and determine whether a referral is required. You will be asked to pre-register with the appropriate hospital and provide demographic and insurance information. This must be completed at least five to ten days before the surgery date. Related Clinics & Centers Michael E. DeBakey Department of Surgery Clinic Michael E. DeBakey Minimally Invasive Surgery Center of Excellence Related Physicians Daniel Albo, MD PhD Samir S. Awad, MD F. Charles Brunicardi, MD, FACS Jimmy F. Howell, MD Kathleen R. Liscum, MD Bradford G. Scott, MD

Your surgeon will give you specific instructions on how to prepare for the procedure. Your stomach must be completely empty to reduce the chance of vomiting during the procedure. It is important that you abstain from food and liquid after midnight the evening before your surgery.

What happens on the day of surgery? You will report to a pre-operative nursing unit, where you will change into a hospital gown. A nurse will review your chart and confirm that all paperwork is in order. You will be taken to a pre-operative holding area, where an anesthesiologist will start an IV. Before any medications are administered, your surgeon will verify your name and the type of procedure you are having. You will then be taken to the operating room. After the appropriate form of anesthesia is administered, surgery will be performed. What type of anesthesia will be used? You will have a pre-operative interview with an anesthesiologist who will ask you questions regarding your medical history. A gastrectomy is performed under general anesthesia, which will keep you asleep during your surgery. What happens during the surgery, and how is it performed? A small thin tube will be inserted through your nose and into your stomach. This nasogastric tube is necessary to drain fluid from the stomach during and after the procedure. A vertical incision is made from below the breastbone down to the navel. A distal partial gastrectomy will be performed if the lower portion of the stomach is to be removed. Your surgeon will clamp off the upper portion of the stomach and the small intestine. The lower portion of the stomach is removed and the upper portion is then attached to the small intestine. A total gastrectomy will be performed to remove the entire stomach. Clamps will be placed on the end of the esophagus and the end of the small intestine attached to the stomach. The stomach will be removed and the esophagus will be attached to the small intestine. If cancer is involved, other organs such as the spleen, a portion of the pancreas and lymph nodes may be removed as well. What happens after the surgery? Once the surgery is completed, you will be taken to a post-operative or recovery unit where a nurse will monitor your progress. It is important that your bandages be kept clean and dry. The nasogastric tube will be

kept in place to keep the stomach empty. It will be removed when the stomach and bowel functions return to normal. This is usually within two to three days. Mild discomfort will occur at the incision site, so your surgeon will prescribe medication for pain management. You will be scheduled for a follow-up appointment within two weeks after you are discharged from the hospital.

How long will I be in the hospital? Most patients are in the hospital from seven to ten days with a gastrectomy. What are the risks associated with a gastrectomy? As with any surgery, there are risks such as bleeding, infection, or an adverse reaction to anesthesia. Your surgeon will inform you of the risks prior to surgery. What should I watch out for? Be sure to call your doctor if any of the following symptoms appear: Fever Worsening pain Redness or swelling around the incision The incision is warm to the touch Drainage from the incision Will there be scar(s)? A scar will remain where the incision was made. It should fade and be less visible over time. When can I expect to return to work and/or resume normal activities? Light activity at home is encouraged after surgery. You can expect to return to normal activities, such as showering, driving, walking up stairs, light lifting, and work as soon as you feel comfortable. If you are taking narcotic medications for pain, you should not drive.

Gastrectomy

Gastrectomy is surgery to remove part or all of the stomach.


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If only part of the stomach is removed, it is called partial gastrectomy If the whole stomach is removed, it is called total gastrectomy

Description The surgery is done while you are under general anesthesia (asleep and pain-free). The surgeon makes a cut in the abdomen and removes all or part of the stomach, depending on the reason for the procedure. Depending on what part of the stomach was removed, the intestine may need to be reconnected to the remaining stomach (partial gastrectomy) or to the esophagus (total gastrectomy). Today, some surgeons perform gastrectomy using a camera. The surgery is done with a few small surgical cuts. The advantages of this surgery, which is called laparoscopy, are a faster recovery, less pain, and only a few small cuts. Why the Procedure is Performed Gastrectomy is used to treat:
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Bleeding Inflammation Non-cancerous (benign) tumors Polyps

Risks Risks of any anesthesia include:


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Severe medication reaction Problems breathing

Risks of any operation include:


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Bleeding Infection

Before the Procedure If you are a smoker, you should stop smoking several weeks before surgery and not start smoking again after surgery. Smoking slows recovery and increases the risk of problems. Tell your doctor or nurse if you need help quitting. Always tell your doctor or nurse:
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If you are or might be pregnant What drugs, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription

During the week before your surgery:


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You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot. Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:


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Do not eat or drink anything after midnight the night before your surgery. Take the drugs your doctor told you to take with a small sip of water. Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure How well you do after surgery depends on the reason for the surgery and your condition. After surgery, there may be a tube in your nose which will help keep your stomach empty. It is removed as soon as your bowels are working well. Most patients have mild discomfort from the surgery. You can easily control this with pain medications. Patients usually stay in hospital for 6-10 days. After discharge, you should perform light activity for the first 4 - 6 weeks. If you take narcotic pain medications, you should not drive. Update Date: 11/5/2010

Definition Gastrectomy is the surgical removal of all or part of the stomach.

Purpose Gastrectomy is performed most commonly to treat the following conditions:


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stomach cancer bleeding gastric ulcer perforation of the stomach wall noncancerous polyps

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device design, instrumentation. www.asmedl.org/MedicalDevices Stomach cancer was the most common form of cancer worldwide in the 1970s and early 1980s, and the incidence rates have always shown substantial variation in different countries. Rates are currently highest in Japan and eastern Asia, but other areas of the world have high incidence rates, including Eastern European countries and parts of Latin America. Incidence rates are generally lower in Western Europe and the United States. Gastrointestinal diseases (including gastric ulcers) affect an estimated 2530% of the world's population. In the United States, 60 million adults experience gastrointestinal reflux at least once a month, and 25 million adults suffer daily from heartburn, a condition that may evolve into ulcers.

Description Gastrectomy for cancer Removal of the tumor, often with removal of the surrounding lymph nodes, is the only curative treatment for various forms of gastric (stomach) cancer. For many patients, this entails removing not only the tumor, but part of the stomach as well. The extent to which lymph nodes should also be removed is a subject of debate, but some studies show additional survival benefits associated with removal of a greater number of lymph nodes. Gastrectomy, either total or subtotal (also called partial), is the treatment of choice for gastric adenocarcinomas, primary gastric lymphomas (originating in the stomach), and the rare leiomyosarcomas (also called gastric sarcomas). Adenocarcinomas are by far the most common form of stomach cancer and are less curable than the relatively uncommon lymphomas, for which gastrectomy offers good chances of survival.

General anesthesia is used to ensure that the patient does not experience pain and is not conscious during the operation. When the anesthesia has taken hold, a urinary catheter is usually inserted to monitor urine output. A thin nasogastric tube is inserted from the nose down into the stomach. The abdomen is cleansed with an antiseptic solution. The surgeon makes a large incision from just below the breastbone down to the navel. If the lower end of the stomach is diseased, the surgeon places clamps on either end of the area, and that portion is excised. The upper part of the stomach is then attached to the small intestine. If the upper end of the stomach is diseased, the end of the esophagus and the upper part of the stomach are clamped together. The diseased part is removed, and the lower part of the stomach is attached to the esophagus. After gastrectomy, the surgeon may reconstruct the altered portions of the digestive tract so that it may continue to function. Several different surgical techniques are used, but, generally speaking, the surgeon attaches any remaining portion of the stomach to the small intestine. Gastrectomy for gastric cancer is almost always done using the traditional open surgery technique, which requires a wide incision to open the abdomen. However, some surgeons use a laparoscopic technique that requires only a small incision. The laparoscope is connected to a tiny video camera that projects a picture of the abdominal contents onto a monitor for the surgeon's viewing. The stomach is operated on through this incision. The potential benefits of laparoscopic surgery include less postoperative pain, decreased hospitalization, and earlier return to normal activities. The use of laparoscopic gastrectomy is limited, however. Only patients with early-stage gastric cancers or those whose surgery is intended only for palliation (pain and symptomatic relief rather than cure) are considered for this minimally invasive technique. It can only be performed by surgeons experienced in this type of surgery.

Gastrectomy for ulcers

Gastrectomy is also occasionally used in the treatment of severe peptic ulcer disease or its complications. While the vast majority of peptic ulcers (gastric ulcers in the stomach or duodenal ulcers in the duodenum) are managed with medication, partial gastrectomy is sometimes required for peptic ulcer patients who have complications. These include patients who do not respond satisfactorily to medical therapy; those who develop a bleeding or perforated ulcer; and those who develop pyloric obstruction, a blockage to the exit from the stomach. The surgical procedure for severe ulcer disease is also called an antrectomy , a limited form of gastrectomy in which the antrum, a portion of the stomach, is removed. For duodenal ulcers, antrectomy may be combined with other surgical procedures that are aimed at reducing the secretion of gastric acid, which is associated with ulcer formation. This additional surgery is commonly a vagotomy , surgery on the vagus nerve that disables the acid-producing portion of the stomach.

Diagnosis/Preparation Before undergoing gastrectomy, patients require a variety of such tests as x rays, computed tomography (CT) scans, ultrasonography, or endoscopic biopsies (microscopic examination of tissue) to confirm the diagnosis and localize the tumor or ulcer. Laparoscopy may be done to diagnose a malignancy or to determine the extent of a tumor that is already diagnosed. When a tumor is strongly suspected, laparoscopy is often performed immediately before the surgery to remove the tumor; this method avoids the need to anesthetize the patient twice and sometimes avoids the need for surgery altogether if the tumor found on laparoscopy is deemed inoperable.

Aftercare After gastrectomy surgery, patients are taken to the recovery unit and vital signs are closely monitored by

To remove a portion of the stomach in a gastrectomy, the surgeon gains access to the stomach via an incision in the abdomen. The ligaments connecting the stomach to the spleen and colon are severed (B). The duodenum is clamped and separated from the bottom of the stomach, or pylorus (C). The end of the duodenum will be stitched closed. The stomach itself is clamped, and the portion to be removed is severed (D). The remaining stomach is attached to the jejunum, another portion of the small intestine (E). ( Illustration by GGS Inc. ) the nursing staff until the anesthesia wears off. Patients commonly feel pain from the incision, and pain medication is prescribed to provide relief, usually delivered intravenously. Upon waking from anesthesia, patients have an intravenous line, a

urinary catheter, and a nasogastric tube in place. They cannot eat or drink immediately following surgery. In some cases, oxygen is delivered through a mask that fits over the mouth and nose. The nasogastric tube is attached to intermittent suction to keep the stomach empty. If the whole stomach has been removed, the tube goes directly to the small intestine and remains in place until bowel function returns, which can take two to three days and is monitored by listening with a stethoscope for bowel sounds. A bowel movement is also a sign of healing. When bowel sounds return, the patient can drink clear liquids. If the liquids are tolerated, the nasogastric tube is removed and the diet is gradually changed from liquids to soft foods, and then to more solid foods. Dietary adjustments may be necessary, as certain foods may now be difficult to digest. Overall, gastrectomy surgery usually requires a recuperation time of several weeks.

Risks Surgery for peptic ulcer is effective, but it may result in a variety of postoperative complications. Following gastrectomy surgery, as many as 30% of patients have significant symptoms. An operation called highly selective vagotomy is now preferred for ulcer management, and is safer than gastrectomy. After a gastrectomy, several abnormalities may develop that produce symptoms related to food intake. They happen largely because the stomach, which serves as a food reservoir, has been reduced in its capacity by the surgery. Other surgical procedures that often accompany gastrectomy for ulcer disease can also contribute to later symptoms. These procedures include vagotomy, which lessens acid production and slows stomach emptying; and pyloroplasty , which enlarges the opening between the stomach and small intestine to facilitate emptying of the stomach. Some patients experience lightheadedness, heart palpitations or racing heart, sweating, and nausea and vomiting after a meal. These may be symptoms of "dumping syndrome," as food is rapidly dumped into the small intestine from the stomach. Dumping syndrome is treated by adjusting the diet and pattern of eating, for example, eating smaller, more frequent meals and limiting liquids.

Patients who have abdominal bloating and pain after eating, frequently followed by nausea and vomiting, may have what is called the "afferent loop syndrome." This is treated by surgical correction. Patients who have early satiety (feeling of fullness after eating), abdominal discomfort, and vomiting may have bile reflux gastritis (also called bilious vomiting), which is also surgically correctable. Many patients also experience weight loss. Reactive hypoglycemia is a condition that results when blood sugar levels become too high after a meal, stimulating the release of insulin, occurring about two hours after eating. A high-protein diet and smaller meals are advised. Ulcers recur in a small percentage of patients after surgery for peptic ulcer, usually in the first few years. Further surgery is usually necessary. Vitamin and mineral supplementation is necessary after gastrectomy to correct certain deficiencies, especially vitamin B 12 , iron, and folate. Vitamin D and calcium are also needed to prevent and treat the bone problems that often occur. These include softening and bending of the bones, which can produce pain and osteoporosis, a loss of bone mass. According to one study, the risk for spinal fractures may be as high as 50% after gastrectomy.

Normal results Overall survival after gastrectomy for gastric cancer varies greatly by the stage of disease at the time of surgery. For early gastric cancer, the five-year survival rate is as high as 8090%; for late-stage disease, the prognosis is bad. For gastric adenocarcinomas that are amenable to gastrectomy, the five-year survival rate is 1030%, depending on the location of the tumor. The prognosis for patients with gastric lymphoma is better, with five-year survival rates reported at 4060%. Most studies have shown that patients can have an acceptable quality of life after gastrectomy for a potentially curable gastric cancer. Many patients will maintain a healthy appetite and eat a normal diet. Others may lose weight and not enjoy meals as

much. Some studies show that patients who have total gastrectomies have more diseaserelated or treatment-related symptoms after surgery and poorer physical function than patients who have subtotal gastrectomies. There does not appear to be much difference, however, in emotional status or social activity level between patients who have undergone total versus subtotal gastrectomies.

Morbidity and mortality rates Depending on the extent of surgery, the risk for postoperative death after gastrectomy for gastric cancer has been reported as 13% and the risk of non-fatal complications as 918%. Overall, gastric cancer incidence and mortality rates have been declining for several decades in most areas of the world.

Read more: Gastrectomy - procedure, recovery, blood, tube, removal, pain, complications, adults, time, operation, medication, heart, risk, cancer, nausea, rate, Definition, Purpose http://www.surgeryencyclopedia.com/FiLa/Gastrectomy.html#ixzz1Qj5VOcDw

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