Gastrectomy

Gastrectomy is a surgical method to remove the whole or portion of the stomach. 

The stomach is a part of the digestive system located between the food pipe (oesophagus) and small intestine. The stomach walls have glands that release acid and enzymes to help digest food and the muscles in the stomach help mix the stomach juices with the food so all the food can be digested properly. From the stomach, the food passes into the duodenum, which is the first part of the small intestine. The digestion of food continues as it passes into the small intestine.

A doctor may recommend this surgery in case of the following conditions:

• Stomach cancer
• Bleeding ulcers in the stomach
• Oesophageal cancer
• Inflammation
• Perforations (holes) in the wall of the stomach
• Non cancerous tumours
• Polyps and severe duodenal or peptic ulcers
• Life-threatening obesity

You may not be eligible to undergo a gastrectomy under the following conditions:

• Spread of cancer (metastasis) to surrounding tissues such as the transverse colon (intestine), aorta (the main artery that carries blood from the heart to the rest of the body), or pancreas (an organ located in the abdomen)
• Metastasis of cancer to distant tissues 
• Peritoneal cancer

You may need the following preoperative preparation:

• Share your entire medical and surgical history with your healthcare provider. 
• You will have to undergo some tests such as a chest X-ray, an electrocardiogram (EKG), and blood tests to make sure that you are otherwise fit enough for the procedure.
• You may also require a CT scan and an upper (gastroduodenal) endoscopy for the diagnosis of stomach disease.
• Inform the doctor if you:
  • Are taking any medicines, including non-prescription medicines. You may need to discontinue blood-thinning medications like aspirin, vitamin E, ibuprofen, or warfarin.
  • Are pregnant
  • Have sleep apnoea 
  • Have any heart device implanted like a pacemaker
  • Have any allergies
• It is better if you quit smoking before the surgery as smokers have a higher risk of complications with any surgery. They also have a longer recovery time.
• Stop having alcohol before the surgery.
• You will need to sign a consent form before the surgery allowing the doctor to operate on you.
• The day before your surgery, you should only have a diet consisting of clear liquids. 
• Do not eat anything after midnight the night before the surgery. You may have water until two hours before the surgery. 
• Do not apply any cream, powder, or lotion on your body on the day of surgery.

Once you are admitted in the hospital, you will be asked to change into a hospital gown and wear compression stockings to prevent blood clots in your legs. You will then be taken to the operating room where an intravenous (IV) line will be placed in your arm. You will be given general anaesthesia, a medication to put you into sleep. The doctor will also insert:

• A nasogastric tube into your stomach through your nose to empty your stomach.
• A urinary catheter into your bladder to drain urine.
• A breathing tube inside your lungs through your mouth.

Gastrectomy may be performed by either of these methods:

• Open surgery: The surgeon will make a large cut on your abdomen to perform the surgery and close the abdomen with stitches or staples after the surgery.
• Laparoscopic surgery: The surgeon will make multiple tiny cuts on your abdomen. Through one of the cuts he/she will insert a laparoscope (a fibre-optic instrument). The laparoscope will let the surgeon view the inside of your abdomen on a screen. Using the images on the screen, the surgeon will then insert surgical tools through the other cuts and perform the procedure. 

The types of gastrectomy are as follows:

• Total gastrectomy: During this procedure, the surgeon will remove your entire stomach and connect your small intestine to your oesophagus. They may additionally remove your lymph nodes and adjacent tissues if the surgery is done for cancer.
• Subtotal or partial gastrectomy: Here, only a part of your stomach will be removed. It is generally the lower part. Just like total gastrectomy, the lymph nodes and nearby tissues will also be removed if the surgery is being done for stomach cancer treatment. 
• Oesophagogastrectomy: In this method, the surgeon will remove part of your oesophagus along with the upper part of your stomach.
• Sleeve gastrectomy: This is performed for the treatment of obesity to help with weight loss. In this, the left part of the stomach is removed.

The surgeon will chose the procedure based on the condition that needs to be treated.

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Open gastrectomy is done as follows:

• The surgeon will make an incision (cut) from the upper mid-region of your abdomen to your navel to expose your stomach and other internal organs. 
• In case of cancer, the surgeon will examine the adjacent organs like the liver and intestines to see if cancer has spread. 
• He/she will then tie up the arteries in the surgical area and move them out away to prevent excessive blood loss. 
• Next, the surgeon will remove the affected portion or whole of your stomach based on the type of procedure. 
• The surrounding lymph nodes will also be examined to check if the disease has spread to them, in which case they will be removed. 
• Finally, the surgeon will rejoin the cut end of the stomach to the ends of the duodenum, and close the cut with stitches.
• He/she will place a drain inside your abdomen to remove any accumulated fluid. 

The procedure for a laparoscopic gastrectomy is similar. 

Sleeve gastrectomy is generally performed laparoscopically. In this surgery, the surgeon uses continuous staples to cut off a longitudinal section of the stomach. The remaining stomach is now banana-shaped and is about 20% to 25% of its original size.

Gatrectomy usually goes on for one to three hours.

After the operation, you will be under observation for a while in the intensive care unit. You will be given an oxygen mask after the surgery, which you may need for some days. Once you are completely awake, you will be taken to the recovery room where your vital signs will be monitored, and you will be provided nutrition by an IV drip.

You will be on pain medication as required and will not be able to drink or eat for about five days. A special X-ray will then be taken to assess your recovery, and then the doctors will decide if you can start consuming liquids and progress to solid food.

The drains, tubes, and catheter will be removed in seven to 10 days. The stitches will also be removed after seven to ten days.

You will be given a discharge when you can move about comfortably and the doctor is satisfied with your recovery; this typically takes about two to three weeks.

You can do the following to take care of yourself after gastrectomy:

• Avoid activities that include pushing, pulling, lifting heavy objects, stretching, or bending for the first few weeks. 
• Start with mild activities like climbing staircases and walking. Do not overdo any exercise. You can gradually increase physical acitivity as you feel comfortable. 
• The dietician will give the following recommendations:
  • Take small meals frequently. 
  • Make your meals as nourishing as possible as you not be able to eat much. 
  • Avoid eating late at night as you may get heartburn (acid reflux).
• You may need prescription pain medication even after you go home. Avoid drinking alcohol or driving if you are taking these medicines. The pain would decrease gradually as the wound heals.
• Change the dressing when they get wet due to drainage. You may stop putting a bandage and leave the wound open once drainage stops.
• Your doctor may allow you to take a warm shower with soap. Clean the site of operation, and gently pat it dry using a towel after the shower.
• You may be allowed to start driving three weeks after the surgery if you are not on any pain medication (pain medication may make you sleepy). However, your doctor may advise you to wait longer.
• Seek counselling and emotional support if needed.

When to see the doctor?

Visit your doctor if you experience any of these symptoms:

• Pain or swelling in the leg
• Increased pain
• Coughing, chest pain, or shortness of breath
• Diarrhoea, vomiting, or nausea
• Fever and chills
• Blood in urine
• Bleeding, pain, or swelling at the incision site
• Urgent urination 
• Redness or discharge from the wound

Gastrectomy can have the following complications:

• Blood clots in legs
• Vitamin deficiency leading to complications such as weak bones and muscles, decreased immunity, or anaemia
• Weight loss
• Obstruction of bowels causing problems in digestion and passing stools
• Wound infection
• Bleeding
• Incisional hernia
• Acid reflux, nausea, vomiting, diarrhoea
• Damage to the surrounding organs
• Dumping syndrome (condition that develops after removal of stomach or a part of it. Where the food suddenly gets dumped into the small intestine Causes weakness, nausea, dizziness and cold sweats) 
• Reaction to anaesthesia like a rash, low blood pressure, wheezing, and swelling
• Narrowing of the bowel due to formation of scar tissue

Your follow-up appointment will be one to three weeks after your discharge.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.