Gastrectomy Surgery: What You Should Know

The Different Types of Gastrectomy Procedures

bracing incision
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A gastrectomy is a surgical procedure that removes, at the minimum, a portion of the stomach. There are multiple types of gastrectomy, which vary in how much of the stomach and surrounding tissues are removed during the procedure.

The Esophagus, Stomach, and Duodenum

To better understand the different types of gastrectomy procedures, it is important to understand the anatomy of the stomach and surrounding tissues.

 Most people understand the stomach and how it works, but they are less familiar with the surrounding organs and tissues.

When a person eats food, the process of digestion starts with the first bite. The teeth help bite or tear food into smaller pieces, then chewing further breaks the food down into more manageable chunks. Saliva contains digestive enzymes that also begin to chemically break down food, but the teeth do the majority of the work at this point in the process. Chewing, depending on how long and how well it is done, can take a tough steak and turn it into a fine paste. Once the food is chewed well, swallowing moves the food from the mouth into the throat. The throat directs the food into the esophagus.

The esophagus is the tube that connects the throat to the stomach, and allows chewed food to slowly move into the stomach after each swallow. Between the esophagus and stomach is a sphincter muscle that can open and close, allowing food to move into the stomach, but preventing it from leaving the top of the stomach.

The stomach adds acid to the food, and agitates the food to continue the process of digestion. After the stomach completes its portion of the digestion process, the pyloric sphincter, a muscle at the bottom of the stomach, opens and closes to allow food to slowly flow out of the stomach and into the first part of the small intestine.

This part of the small intestine is called the duodenum.

Types of Gastrectomy

The different types of gastrectomy are as follows:

  • Partial gastrectomy: This is a gastrectomy procedure where the lower part of the stomach is removed.
  • Sleeve gastrectomy: This procedure surgically removes the left side of the stomach.
  • Esophagogastrectomy: A surgical procedure where the top of the stomach, the cardiac sphincter, and part of the esophagus is removed.
  • Total gastrectomy: The entirety of the stomach is removed in this surgical procedure. Portions of the esophagus and duodenum may also be removed.

Reasons for a Gastrectomy

There are multiple reasons why a gastrectomy may be performed. The nature of the problem will dictate the type of gastrectomy that is performed, and how much tissue must be removed. In general, when treating digestive diseases, an effort is made to minimize the amount of tissues that is removed, preserving as much good tissue as is possible while removing bad tissue.

Obesity

In the past, gastrectomy surgeries were performed to treat a disease or condition affecting the stomach. Weight loss was considered a side effect, or even a complication, after surgical treatment of another disease.

In recent years, gastrectomy has been used as a bariatric surgery, which is a surgical procedure done to treat obesity.

For obese individuals, decreasing the size of the stomach can lead to a notable decrease in excess body weight. Unlike some weight loss surgeries, the sleeve gastrectomy patients are at low risk for malnutrition due to poor absorption of nutrients, but still are able to shed substantial excess pounds.

Unlike other types of gastrectomy that seek to preserve as much healthy tissue as is possible, when the sleeve gastrectomy is performed for the purpose of weight loss, there is significant healthy tissue that is removed to significantly decrease the patient’s capacity for food.

This leads to the patient feeling full with far less food, and in turn leads to weight loss.

Ulcers: Peptic ulcers, or ulcers that form in the stomach, esophagus or duodenum, can cause significant pain and bleeding. For some patients, there is a small but steady loss of blood that can cause ongoing anemia. For others, the bleeding is both sudden and urgent, requiring immediate attention. Ulcers are typically first diagnosed when a patient seeks a diagnosis for their abdominal pain. An esophagogastroduodenoscopy (EGD), also known as an Upper GI, is typically performed allowing a physician to see the inside of the stomach so a diagnosis can be made.

A gastrectomy is rarely the first choice of treatment for ulcers. Depending on the type of ulcer, medication may be the first line of treatment, followed by other interventions to stop bleeding such as the injection of epinephrine, or an ablation procedure that uses heat to stop blood loss. It is when these types of treatments fail to heal the ulcers or fail to stop the bleeding that a gastrectomy is typically considered.

Tumors

Cancerous and non-cancerous tumors can occur in the stomach. When they do occur, and less invasive methods of removing the tumors are unsuccessful or unlikely to lead to the desired outcome, a gastrectomy may be considered. The amount, size, and location of the tumor(s) will help determine what portion of the stomach, esophagus, and duodenum must be removed.

Bleeding

While peptic ulcers are a common cause of bleeding in the stomach, there are other types of problems that may also lead to bleeding.  One of the more common is an issue where a blood vessel is on the surface of the tissue on the inside of the tissue of the digestive system, called an angioectasia. Also known as arteriovenous malformations, or AVMs, this type of abnormal blood vessel can cause bleeding.

Before Gastrectomy

Prior to the gastrectomy procedure, the patient will need to refrain from eating or drinking for six or more hours in preparation for surgery. Ideally, all food and fluid will need to have moved out of the stomach for the procedure, so the patient typically won’t eat after supper the day prior to the surgery. For patients who have a slow digestive system, clear liquids may be the only thing taken by mouth the day before the procedure to increase the likelihood that the stomach will be completely empty.

During Gastrectomy

The gastrectomy procedure begins with general anesthesia, to make sure the patient experiences no pain and remains unconscious during surgery. Once the patient is sedated, has been intubated and placed on the ventilator, the surgery can begin.

The gastrectomy procedure can be performed in one of two ways: the traditional procedure where a large incision is made on the abdomen, or the newer minimally invasive version where tiny incisions including an incision in the belly button are made, and the surgeon uses a tiny camera inserted into one of the incisions to watch the surgery on a monitor.

Once the instruments are in place, the necessary section of the stomach is cut away and sewn back together. For a total gastrectomy, where the entire stomach is removed, the esophagus is connected to the duodenum. If a section of the stomach is removed the edges can be sewn back together to make a whole, but smaller, stomach.

Once the surgeon finishes the procedure, the instruments are removed, the incision(s) are closed, and the anesthesia is stopped so the patient can wake up. Once the patient starts to wake up, the breathing tube can be removed so that the patient can begin breathing on their own without the ventilator.

Recovering After Gastrectomy

The process of recovering after a gastrectomy is often focused on slowly reintroducing foods into the diet. Ideally, foods will be well tolerated with the newly altered stomach, but many patients need to slowly return to their normal diet and during the process may discover that they cannot yet tolerate some of their favorite foods. Most patients will start with a bland pureed diet and progress to harder to digest foods as they are able. Patients who have the sleeve gastrectomy for weight loss will have a strict plan for eating that is provided by their surgeon to maximize their weight loss.

For some patients, there may be a tube called a nasogastric tube inserted during surgery. This tube is inserted into the nose, down the throat, and into the stomach. This allows the staff to remove any gastric fluid that may build up, which can help decrease nausea and prevent vomiting. This tube is typically removed when the patient is well enough to tolerate both food and fluids.

The gastrectomy is a fairly serious surgery and many patients will require some form of pain medication during the recovery process. Abdominal incisions are often very tender, and can be irritated by simple day to day occurrences such as sneezing and coughing. During the recovery period, the abdominal incisions, whether they are the traditional large incision or the small laparoscopic incisions, should be braced with a hand or pillow during sneezes and coughs to help prevent complications.

Risks of Gastrectomy

In addition to the risks of anesthesia and the general risks of surgery, the gastrectomy procedure has additional risks that must be considered when surgery is recommended. These risks must be weighed against the risk of not proceeding. For example, a patient who has been told they need a partial gastrectomy due to bleeding ulcers would have to weigh the risk of having ulcers that continue to bleed against the risks that are present when having surgery to fix the problem. Some of these risks include:

  • Bleeding: Like most surgeries, there is always a risk of bleeding. This risk is higher in gastrectomy patients who are having surgery because of bleeding in the digestive tract.
  • Infection: It is possible that infection will occur after this procedure, in the abdominal incisions or in the digestive tract itself.
  • Leaking: There is a chance that the suture line where the stomach is sewn back together will leak. This can be a serious complication as the leaking of acid and stomach contents is not only likely to cause a serious infection, but the leaking of these things into the abdomen will be very irritating to the tissues that are nearby.
  • Dehiscence and Evisceration: This is a very serious complication where surgical incisions open up and may allow abdominal organs to try to exit the body through the incisions. It can typically be prevented by bracing incisions when they under stress, such as during sneezing.
  • Decreased Absorption: Some patients have difficulty absorbing iron and other nutrients from their food after the procedure and will require supplementation.
  • Iron Deficiency Anemia: Due to decreased absorption of iron, some patients become anemic.  Iron is an essential building block of blood, without iron the body is unable to build blood cells and the result over time is anemia.
  • Stricture: A narrowing of the esophagus due to scar tissue at the surgical site, this complication can make it difficult to swallow food without it “sticking” between the throat and stomach.
  • Nausea and Vomiting
  • Dumping Syndrome: A decreased ability to digest sugars/simple carbohydrates can lead to food “dumping” from the stomach into the duodenum rapidly, leading to cramping, diarrhea, feeling faint, cold sweats, nausea, and bloating.

A Word From Verywell

The gastrectomy procedure is a major surgery, but it is often a very successful one for treating many serious digestive diseases. It is also considered a very safe surgery. The procedure may result in a hospital stay of a week or longer, but most patients are eventually able to go back to their normal life—and favorite foods—after the procedure.

Source:

Gastrectomy.  MedlinePlus. Accessed October, 2017.  https://medlineplus.gov/ency/article/002945.htm

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