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Gastrectomy

By

Megan Freedman

What is a gastrectomy?

A gastrectomy is the surgical removal of part or all of the stomach. Your doctor may recommend a gastrectomy to treat cancer, benign tumors, severe ulcers, and other conditions that damage the stomach. Your doctor may perform a gastrectomy for some ulcers of the small intestine just after your stomach. Some types of bariatric surgery (weight-loss surgery) include a gastrectomy.

Gastrectomy is a major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a gastrectomy.

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Types of gastrectomy

The types of gastrectomy procedures include:

  • Partial gastrectomy is the removal of part of the stomach. Your doctor attaches your small intestine to the remaining healthy part of the stomach.

  • Total gastrectomy is the removal of the entire stomach. Your doctor attaches the small intestine to the esophagus.

  • Sleeve gastrectomy (also called vertical sleeve gastrectomy and stomach stapling) is the removal of a large part of the stomach to help with weight loss. Your doctor uses staples to create a smaller stomach and attaches the small intestine to the remaining stomach.

Why is a gastrectomy performed?

Your doctor may recommend a gastrectomy to treat certain diseases and conditions of the stomach, and sometimes the small intestine. Your doctor may only consider gastrectomy if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a gastrectomy.

Your doctor may recommend a gastrectomy for:

  • Benign tumors in the stomach

  • Perforations (holes) and bleeding in the stomach caused by a severe peptic ulcer

  • Stomach cancer, also known as gastric cancer

  • Ulcers of the duodenum, the first part of the small intestine

Doctors sometimes recommend a total gastrectomy as a preventive measure for certain types of hereditary stomach cancer. These include hereditary diffuse gastric cancer.
A vertical sleeve gastrectomy is one type of weight-loss surgery to treat severe obesity. This type of gastrectomy leads to weight loss by making the stomach smaller and limiting the amount of food you can consume.

Who performs a gastrectomy?

The following specialists perform gastrectomies:

  • General surgeons specialize in the surgical treatment of diseases of the abdomen, including appendicitis, hernia, and gallbladder, stomach and intestinal diseases.

  • Surgical oncologists specialize in the surgical treatment of cancer.

  • Bariatric surgeons specialize in weight-loss surgery.

General surgeons and surgical oncologists often specialize in certain types of surgery, such as gastrointestinal, or GI surgery. When you are looking for a surgeon, ask about their experience with gastrectomy, including how many gastrectomies they have performed and by what technique.

How is a gastrectomy performed?

Your surgeon will perform your gastrectomy by making an incision in your abdomen to remove the damaged part of your stomach. The healthy part of the stomach is reattached to the small intestine. If your whole stomach needs to be removed (total gastrectomy), your surgeon will connect the small intestine directly to the esophagus.

Surgical approaches to gastrectomy

Your doctor will perform a gastrectomy using one of the following approaches:

  • Minimally invasive surgery is a procedure performed by inserting special instruments and a laparoscope through small incisions in the abdomen. The laparoscope is a thin, lighted camera that transmits pictures of the inside of your body to a video screen. Your doctor sees the inside of your abdomen on the computer screen as he or she performs the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your doctor will make small incisions instead of a larger one used in open surgery. He or she can thread surgical tools around structures, such as muscle, instead of cutting through or displacing them as in open surgery.

  • Open surgery is performed by making a large incision in the abdomen. Open surgery allows your surgeon to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. This is because it causes more trauma to tissues. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

In some cases, your surgeon may decide after beginning a minimally invasive procedure that you require an open surgery to safely and most effectively complete your surgery. Your surgeon will determine which type and method of surgery is best for you and how long you need to stay in the hospital based on certain factors. These include your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different gastrectomy procedures and ask why your surgeon will use a particular type of surgery for you.

Types of anesthesia that may be used

Your doctor will perform a gastrectomy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.

What to expect the day of your gastrectomy

The day of your surgery, you can expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you understand and sign the surgical consent.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. The surgical team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.

  • A surgical team member will start an IV.

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • Your anesthesiologist will place a tube in your windpipe to protect and control your breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • Once you are asleep, a surgical team member will insert a tube through your nose and pass it through your throat into your stomach. This removes stomach contents in preparation for the gastrectomy. It stays in after the surgery for several days to rest your remaining stomach.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of gastrectomy?

As with all surgeries, a gastrectomy involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery

The general risks of surgical procedures include:

  • Anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock

  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis

  • Infection 

Potential complications of gastrectomy

The majority of gastrectomy procedures are successful. However, complications of gastrectomy can occur and become serious. Potential complications of gastrectomy include:

  • Dehydration

  • Difficulty swallowing (dysphagia)

  • Dumping syndrome (post-gastrectomy syndrome), a rapid emptying of stomach contents into the small intestine causing symptoms, such as nausea, vomiting, cramping, and abdominal pain

  • Gallstones

  • Gastritis (irritated stomach tissue), gastroesophageal reflux (regurgitation), and heartburn

  • Hernia

  • Injury to your abdominal organs or major blood vessels during the surgery

  • Intestinal stricture (narrowing)

  • Leaking of digested foods and digestive juices into the abdominal