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. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
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:
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
Gastritis (irritated stomach tissue), gastroesophageal reflux (regurgitation), and heartburn
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 cavity from the area where organs are sewed together
Malnutrition including vitamin and mineral deficiencies, which can lead to long-term complications. These include osteoporosis, anemia, and permanent nervous system damage.
Nausea or vomiting from eating more than your smaller stomach or digestive tract can hold
Scarring of the stomach, intestines, or esophagus
leading to digestive tract blockages
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This may include consultation with a registered dietician.
Informing your doctor if you are nursing or there is any possibility that you may be pregnant
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my gastrectomy?
You are an important member of your own healthcare team. The steps you take before surgery can significantly improve your comfort and outcome after the procedure. You can prepare for gastrectomy by:
Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include an abdominal CT scan, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing weight before surgery through a healthy diet and exercise plan
Not eating or drinking just prior to surgery as directed. Your doctor may cancel your surgery if you eat or drink too close to the start of the procedure because you can choke on stomach contents during general anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during their doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need a gastrectomy? Are there any other options for treating my condition?
What type of gastrectomy procedure will I need?
How long will the procedure take? When can I go home?
What kind of restrictions will I have after the surgery? When can I return to work and other activities? When can I resume sexual activity?
What kind of diet will I need to follow?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my usual medications?
How will you manage my pain?
When should follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my gastrectomy?
Knowing what to expect can help make your road to recovery after gastrectomy as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after your gastrectomy until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
Following the recovery room, you will need to stay in the hospital for three to ten days. Your surgical and medical teams will monitor your healing and help you slowly transition back to eating and drinking.
You will have a nasogastric (NG) tube attached to a pump. The NG tube clears your remaining stomach of all matter so that your digestive organs can rest and heal. Within a few days, you will have clear liquids. Your care team will remove your NG tube when you can tolerate the liquids and your stomach and intestines are moving normally again. You will start drinking thicker liquids, then move to pureed foods and soft solid foods.
If you had a vertical sleeve gastrectomy for weight loss, you will remain on a liquid diet for a longer period of time.
Recovery after surgery is a gradual process. Recovery time varies depending on the specific type of gastrectomy, your general health, age, and other factors. You can generally perform light activities after you go home from the hospital. Full recovery may take a few months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. You will have discomfort after your surgery, but your doctor and care team will manage your pain so you are comfortable and can get the rest you need. Contact a team member or your doctor if your pain gets worse or changes Because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after your gastrectomy. Call your doctor for questions or concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Severe nausea and vomiting
Unexpected drainage, pus, redness or swelling of your incision
How might a gastrectomy affect my everyday life?
A gastrectomy may cure your condition or significantly reduce your symptoms so you can lead a more active, healthy life. For example, a gastrectomy for a tumor may help relieve abdominal pain and allow you to resume eating many of the foods you love. A gastrectomy for stomach cancer will most likely include radiation and chemotherapy, both of which improve your prognosis compared to surgery alone.
In most cases, life after gastrectomy includes performing many of your former everyday activities, such as exercising and working. In fact, many people who have a gastrectomy can enjoy activities they were not able to do before surgery.
However, gastrectomy will also cause significant changes to your body that affect your dietary habits. You may have to avoid certain types of food, eat much smaller, more frequent meals, and consume beverages in much smaller quantities. Your healthcare team, including your surgeon, primary care doctor, nurse, and registered dietician will work with you to understand your new dietary needs. With time, you will learn to adapt your dietary habits so you can feel satisfied and comfortable with your new digestive process.
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- Gastrectomy. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/002945.htm.
- Hereditary Diffuse Gastric Cancer Syndrome (CDH1). Stanford Medicine Cancer Institute. http://cancer.stanford.edu/patient_care/services/geneticCounseling/HDGC.html.
- Post-Gastrectomy Syndrome Overview. Cleveland Clinic. http://my.clevelandclinic.org/disorders/post_gastrectomy_syndrome/dd_overview.aspx.
- Vertical sleeve gastrectomy. PubMed Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004677/.
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