A gastrectomy is a medical procedure where all or part of the stomach is surgically removed. Removing the stomach does not remove the body’s ability to digest liquids and foods.

Gastrectomy is used to treat stomach problems that are not helped by other treatments.

Some types of gastrectomy can also be used to treat uncontrolled obesity. By making the stomach smaller, it fills more quickly. This may help you eat less. However, gastrectomy is only an appropriate obesity treatment when other options have failed.

The stomach is a C-shaped organ that is part of the digestive system and lies under the left lower ribs and left upper part of the abdomen

The stomach is connected to the gullet (oesophagus) at its top and the first sections of the duodenum (small intestine) at its bottom. During the operation, the surgeon connects the oesophagus either to the small intestine or the remaining section of stomach. This means that you’ll still have a working digestive system, although it won’t function as well as it did before.

gastrectThere are four types of Gastrectomy:

  • Total Gastrectomy – the complete removal of stomach
  • Partial Gastrectomy – the lower half part of the stomach is removed
  • Sleeve Gastrectomy – the left side of the stomach is removed
  • Oesophago Gastrectomy – the part of the oesophagus (gullet) and upper part of stomach is removed

Gastrectomy is used to treat

  • Benign (non-cancerous) tumors
  • Bleeding
  • Inflammation
  • Perforations in the stomach wall
  • Polyps (growths inside your stomach)
  • Stomach cancer
  • Ulcers (open sores in your stomach)

Gastrectomy for cancer

The only curative treatment for various forms of gastric or stomach cancer is removal of the tumour which may involve removal of lymph nodes in the surrounding area. Removing a part of the stomach may also be required in certain patients along with removal of the tumour.

Gastrectomy may be total or partial. It is the chosen treatment for gastric adenocarcinomas, primary gastric lymphomas and leiomyosarcomas. Primary gastric lymphomas are which originate in the stomach while leiomyosarcomas are rare often referred to as gastric Sarcomas.

The most common form of stomach cancer is Adenocaricinomas and are less curable. Gastrectomy offers good survival chances for the uncommon lymphomas.

Gastrectomy for ulcers

Medication can manage a vast majority of peptic ulcers. Peptic ulcers are gastric ulcers in the stomach or duodenal ulcers in the duodenum. However partial gastrectomy may be sometimes used or required for patients with peptic ulcers or complications. These patients would largely comprise of people not responding to medical therapy or those who may develop a bleeding or perforated ulcer. It may also be used in a situation of pyloric obstruction which means that a blockage is present at the exit of the stomach.

Antrectomy is another surgical procedure which may be used to treat severe ulcers. It is a limited form of gastrectomy which removes a portion of the stomach called the Antrum is removed.

Treatment

There are two different ways to perform gastrectomy. All are performed under general anesthesia.

The surgery is done while the person is under general anesthesia (asleep and pain-free). 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. The duodenum is clamped and separated from the bottom of the stomach, or pylorus. The end of the duodenum will be stitched closed. The stomach itself is clamped, and the portion to be removed is severed. The remaining stomach is attached to the jejunum, another portion of the small intestine.

Total Gastrectomy may involve removing the stomach completely. In such a case the tube which goes directly into the small intestine will be inserted till the resumption of bowel function. Bowel sounds need to be monitored over the next 2-3 days after surgery.

Bowel sounds and movement are indications of the healing process also the commencement of a liquid diet for the patient. Once liquid diet is tolerated well, the tube may be removed and the diet may be gradually moved over to semi solid or soft foods.

Open Surgery

This involves a single large incision. The surgeon will pull back skin, muscle, and tissue to access the stomach.

Laparoscopic Surgery

This is a minimally-invasive surgery. It uses small incisions and specialized tools. It involves less pain and a quicker recovery time. It is also known as “keyhole surgery” or laparoscopically assisted gastrectomy (LAG).

 

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