Stomach Surgery (Gastrectomy)

What is the Stomach?

It is hollow muscular organ connected to the esophagus. Its function is to break down food through a combination of enzymes, hydrochloric acid and a muscular churning action before transferring the digested food to the duodenum.

Stomach Diseases

Cancers: 95% are adenocarcinomas. The remaining 5% include: carcinoids, lymphomas, and GI stromal tumors. Adenocarcinomas originate from the epithelium (inner lining), but commonly metastasize (spread) quickly through the wall of the stomach, the blood stream or the lymphatic system. The most frequent symptoms are weight loss, abdominal pain, vomiting and anorexia. Diagnosis is made by upper endoscopy and biopsy. Staging to determine how advanced the cancer is includes a CT scan and laparoscopy.  Patients who have a positive cytology (cancer cells in peritoneal fluid) found by laparoscopy have life expectancy of 3 to 9 months and would not benefit from a laparotomy (big abdominal incision) and a gastrectomy (removal of part or all the stomach). Carcinoids and GI stromal tumors are usually curable by removing a portion of the stomach, often laparoscopically.  Treatment of gastric lymphomas requires surgery, or chemotherapy or both. Thankfully, surgery alone is efficacious, as is chemotherapy alone, both curing about 75% of patients.

Ulcers: Most ulcers can be treated with medicine and do not require surgery.60% of gastric and 90% of duodenal ulcers are secondary to Helicobacter pylori infections and eradication of this bacteria will treat most ulcers. Indications for surgery include: bleeding, perforation, obstruction, or failure to respond to medical therapy.

Stomach Surgeries

  • Total gastrectomy: removal of the entire stomach with connection of the esophagus to the jejunum. Since eating is difficult, a feeding tube is usually placed in the jejunum. This is usually done for cancer.
  • Proximal gastrectomy: removal of the upper stomach with connection of the lower stomach to the esophagus. Usually done for cancer.
  • Distal gastrectomy: removal of the distal stomach with connection of the upper stomach to either the duodenum (Bilroth I) or the jejunum (Bilroth II). Can be done for cancer or for ulcer disease. If done for ulcer disease, a vagotomy (division of the vagus nerve to the stomach contributing to acid production) is also performed.
  • Wedge resections: removal of part of the stomach without an anastamosis, often laparoscopically frequently for carcinoid tumors or GI stromal tumors
  • Vagotomy and Pyloroplasty/Highly selective vagotomy: rarely performed ulcer operations in which a part or the entire vagus nerve is divided.

Complications of Stomach Surgery

Pulmonary (pneumonias, etc.) about 25%
Leaks of the anastamosis about 5 to 10%
Infections about 15%
Cardiac about 5 %
Bleeding about 2%
Blood clots about 2 %
DEATH about 5 %

 

PreOp Evaluation

  • Upper endoscopy, CT scan, and possibly cardiac and pulmonary evaluation.
  • Do not take blood thinners 5 days before surgery.
  • Typically patients will be admitted the day before surgery for a bowel prep.
  • You will be on clear liquids the day before your surgery.
  • Do not eat and drink within 6 hours of surgery.
  • If you have had prior Staph infections, please let your surgeon know.
  • If a total gastrostomy has been performed, you will require some form of extra nutrition. This is usually through a feeding tube, but occasionally through the bloodstream. Home healthcare agencies will assist you.
  • You can shower; walking is encouraged, no lifting more than 10 pounds for 6weeks, no driving for about 3 weeks.

Post-op care

  • If a total gastrostomy has been performed, you will require some form of extra nutrition. This is usually through a feeding tube, but occasionally through the bloodstream. Home healthcare agencies will assist you.
  • You can shower; walking is encouraged, no lifting more than 10 pounds for 6weeks, no driving for about 3 weeks.

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