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Gastrectomy

Gastrectomy

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Gastrectomy What is a gastrectomy and why is it necessary? A gastrectomy is the surgical removal of all or part of the stomach.

It is performed as treatment for stomach cancer, noncancerous polyps, gastric ulcers or a hole (perforation) in the stomach wall. The stomach is the digestive organ that is connected between the esophagus and the small intestine. Food enters the stomach through the esophagus where it is broken down and then transferred to the small intestine where the nutrients are absorbed. If a partial gastrectomy is performed, only a portion of the stomach is removed. If the entire stomach is removed, the esophagus will be connected directly to the small intestine. Dietary changes may be necessary to help the body adapt to changes in the digestive tract. Details of the procedure What do I need to do before surgery? Please contact your insurance company to verify coverage and determine whether a referral is required. You will be asked to pre-register with the appropriate hospital and provide demographic and insurance information. This must be completed at least five to ten days before the surgery date. Related Clinics & Centers Michael E. DeBakey Department of Surgery Clinic Michael E. DeBakey Minimally Invasive Surgery Center of Excellence Related Physicians Daniel Albo, MD PhD Samir S. Awad, MD F. Charles Brunicardi, MD, FACS Jimmy F. Howell, MD Kathleen R. Liscum, MD Bradford G. Scott, MD

Your surgeon will give you specific instructions on how to prepare for the procedure. Your stomach must be completely empty to reduce the chance of vomiting during the procedure. It is important that you abstain from food and liquid after midnight the evening before your surgery.

A total gastrectomy will be performed to remove the entire stomach. The lower portion of the stomach is removed and the upper portion is then attached to the small intestine. If cancer is involved. What type of anesthesia will be used? You will have a pre-operative interview with an anesthesiologist who will ask you questions regarding your medical history. Your surgeon will clamp off the upper portion of the stomach and the small intestine. You will be taken to a pre-operative holding area.What happens on the day of surgery? You will report to a pre-operative nursing unit. A vertical incision is made from below the breastbone down to the navel. It is important that your bandages be kept clean and dry. where you will change into a hospital gown. This nasogastric tube is necessary to drain fluid from the stomach during and after the procedure. The stomach will be removed and the esophagus will be attached to the small intestine. a portion of the pancreas and lymph nodes may be removed as well. The nasogastric tube will be . you will be taken to a post-operative or recovery unit where a nurse will monitor your progress. You will then be taken to the operating room. After the appropriate form of anesthesia is administered. What happens during the surgery. A gastrectomy is performed under general anesthesia. surgery will be performed. and how is it performed? A small thin tube will be inserted through your nose and into your stomach. other organs such as the spleen. where an anesthesiologist will start an IV. What happens after the surgery? Once the surgery is completed. A nurse will review your chart and confirm that all paperwork is in order. Clamps will be placed on the end of the esophagus and the end of the small intestine attached to the stomach. your surgeon will verify your name and the type of procedure you are having. A distal partial gastrectomy will be performed if the lower portion of the stomach is to be removed. Before any medications are administered. which will keep you asleep during your surgery.

. It will be removed when the stomach and bowel functions return to normal. you should not drive. infection.kept in place to keep the stomach empty. or an adverse reaction to anesthesia. If you are taking narcotic medications for pain. This is usually within two to three days. light lifting. and work as soon as you feel comfortable. Mild discomfort will occur at the incision site. How long will I be in the hospital? Most patients are in the hospital from seven to ten days with a gastrectomy. Your surgeon will inform you of the risks prior to surgery. there are risks such as bleeding. You will be scheduled for a follow-up appointment within two weeks after you are discharged from the hospital. When can I expect to return to work and/or resume normal activities? Light activity at home is encouraged after surgery. driving. such as showering. What are the risks associated with a gastrectomy? As with any surgery. It should fade and be less visible over time. walking up stairs. What should I watch out for? Be sure to call your doctor if any of the following symptoms appear: ‡ Fever ‡ Worsening pain ‡ Redness or swelling around the incision ‡ The incision is warm to the touch ‡ Drainage from the incision Will there be scar(s)? A scar will remain where the incision was made. so your surgeon will prescribe medication for pain management. You can expect to return to normal activities.

Why the Procedure is Performed Gastrectomy is used to treat: y y y y Bleeding Inflammation Non-cancerous (benign) tumors Polyps Risks Risks of any anesthesia include: y y Severe medication reaction Problems breathing Risks of any operation include: y y Bleeding Infection . which is called laparoscopy. are a faster recovery. Depending on what part of the stomach was removed. it is called total gastrectomy Description The surgery is done while you are under general anesthesia (asleep and pain-free). the intestine may need to be reconnected to the remaining stomach (partial gastrectomy) or to the esophagus (total gastrectomy). y y If only part of the stomach is removed. The surgery is done with a few small surgical cuts. it is called partial gastrectomy If the whole stomach is removed.Gastrectomy Gastrectomy is surgery to remove part or all of the stomach. some surgeons perform gastrectomy using a camera. Today. The surgeon makes a cut in the abdomen and removes all or part of the stomach. depending on the reason for the procedure. The advantages of this surgery. and only a few small cuts. less pain.

Ask your doctor which drugs you should still take on the day of your surgery. there may be a tube in your nose which will help keep your stomach empty. After discharge. Most patients have mild discomfort from the surgery. After surgery. warfarin (Coumadin). you should perform light activity for the first 4 . ibuprofen (Advil. Tell your doctor or nurse if you need help quitting.Before the Procedure If you are a smoker. You can easily control this with pain medications. Update Date: 11/5/2010 . vitamin E. Smoking slows recovery and increases the risk of problems. even ones you bought without a prescription During the week before your surgery: y y You may be asked to stop taking aspirin. It is removed as soon as your bowels are working well.6 weeks. and any other drugs that make it hard for your blood to clot. Always tell your doctor or nurse: y y If you are or might be pregnant What drugs. If you take narcotic pain medications. Take the drugs your doctor told you to take with a small sip of water. you should stop smoking several weeks before surgery and not start smoking again after surgery. Motrin). On the day of your surgery: y y y Do not eat or drink anything after midnight the night before your surgery. Patients usually stay in hospital for 6-10 days. vitamins. After the Procedure How well you do after surgery depends on the reason for the surgery and your condition. herbs. and other supplements you are taking. you should not drive. Your doctor or nurse will tell you when to arrive at the hospital.

GetResearchSmart. Purpose Gastrectomy is performed most commonly to treat the following conditions: y y y y stomach cancer bleeding gastric ulcer perforation of the stomach wall noncancerous polyps Demographics Ads by Google Clinical Trial IVRS/IWRS Deft Trial and Supply Management Optimize Subject and IMP progress www.com clinical trials Diagnostic Devices for Asthma COPD Clinical Trials and Telemedicine www.com Human Research Volunteer? Get the Facts.org Medical Devices Latest peer-reviewed r&d on medical .Definition Gastrectomy is the surgical removal of all or part of the stomach.hmdclinical.spirometry. Get Research Smart Today. Know the Risks.

60 million adults experience gastrointestinal reflux at least once a month. Description Gastrectomy for cancer Removal of the tumor. instrumentation. Gastrointestinal diseases (including gastric ulcers) affect an estimated 25±30% of the world's population. for which gastrectomy offers good chances of survival. For many patients. . Gastrectomy. but part of the stomach as well. primary gastric lymphomas (originating in the stomach). is the treatment of choice for gastric adenocarcinomas. this entails removing not only the tumor. but some studies show additional survival benefits associated with removal of a greater number of lymph nodes.org/MedicalDevices Stomach cancer was the most common form of cancer worldwide in the 1970s and early 1980s. a condition that may evolve into ulcers. and the incidence rates have always shown substantial variation in different countries. In the United States. either total or subtotal (also called partial).device design. Adenocarcinomas are by far the most common form of stomach cancer and are less curable than the relatively uncommon lymphomas. Incidence rates are generally lower in Western Europe and the United States. Rates are currently highest in Japan and eastern Asia. www. and 25 million adults suffer daily from heartburn. including Eastern European countries and parts of Latin America.asmedl. but other areas of the world have high incidence rates. often with removal of the surrounding lymph nodes. The extent to which lymph nodes should also be removed is a subject of debate. is the only curative treatment for various forms of gastric (stomach) cancer. and the rare leiomyosarcomas (also called gastric sarcomas).

The diseased part is removed. The potential benefits of laparoscopic surgery include less postoperative pain. generally speaking. However. and that portion is excised.General anesthesia is used to ensure that the patient does not experience pain and is not conscious during the operation. Gastrectomy for ulcers . the end of the esophagus and the upper part of the stomach are clamped together. a urinary catheter is usually inserted to monitor urine output. and the lower part of the stomach is attached to the esophagus. When the anesthesia has taken hold. If the lower end of the stomach is diseased. some surgeons use a laparoscopic technique that requires only a small incision. however. Gastrectomy for gastric cancer is almost always done using the traditional open surgery technique. the surgeon may reconstruct the altered portions of the digestive tract so that it may continue to function. The use of laparoscopic gastrectomy is limited. The abdomen is cleansed with an antiseptic solution. The surgeon makes a large incision from just below the breastbone down to the navel. which requires a wide incision to open the abdomen. the surgeon attaches any remaining portion of the stomach to the small intestine. the surgeon places clamps on either end of the area. Several different surgical techniques are used. The laparoscope is connected to a tiny video camera that projects a picture of the abdominal contents onto a monitor for the surgeon's viewing. and earlier return to normal activities. The stomach is operated on through this incision. A thin nasogastric tube is inserted from the nose down into the stomach. It can only be performed by surgeons experienced in this type of surgery. The upper part of the stomach is then attached to the small intestine. but. Only patients with early-stage gastric cancers or those whose surgery is intended only for palliation (pain and symptomatic relief rather than cure) are considered for this minimally invasive technique. If the upper end of the stomach is diseased. After gastrectomy. decreased hospitalization.

antrectomy may be combined with other surgical procedures that are aimed at reducing the secretion of gastric acid. or endoscopic biopsies (microscopic examination of tissue) to confirm the diagnosis and localize the tumor or ulcer. surgery on the vagus nerve that disables the acid-producing portion of the stomach. Aftercare After gastrectomy surgery. a blockage to the exit from the stomach. patients are taken to the recovery unit and vital signs are closely monitored by . These include patients who do not respond satisfactorily to medical therapy. a portion of the stomach. a limited form of gastrectomy in which the antrum. computed tomography (CT) scans. ultrasonography. this method avoids the need to anesthetize the patient twice and sometimes avoids the need for surgery altogether if the tumor found on laparoscopy is deemed inoperable. While the vast majority of peptic ulcers (gastric ulcers in the stomach or duodenal ulcers in the duodenum) are managed with medication. patients require a variety of such tests as x rays. partial gastrectomy is sometimes required for peptic ulcer patients who have complications. Diagnosis/Preparation Before undergoing gastrectomy. For duodenal ulcers. The surgical procedure for severe ulcer disease is also called an antrectomy . This additional surgery is commonly a vagotomy . which is associated with ulcer formation.Gastrectomy is also occasionally used in the treatment of severe peptic ulcer disease or its complications. those who develop a bleeding or perforated ulcer. Laparoscopy may be done to diagnose a malignancy or to determine the extent of a tumor that is already diagnosed. When a tumor is strongly suspected. and those who develop pyloric obstruction. laparoscopy is often performed immediately before the surgery to remove the tumor. is removed.

The ligaments connecting the stomach to the spleen and colon are severed (B). or pylorus (C). ( Illustration by GGS Inc. ) the nursing staff until the anesthesia wears off. another portion of the small intestine (E). a . The stomach itself is clamped. usually delivered intravenously. the surgeon gains access to the stomach via an incision in the abdomen.To remove a portion of the stomach in a gastrectomy. The remaining stomach is attached to the jejunum. patients have an intravenous line. and the portion to be removed is severed (D). and pain medication is prescribed to provide relief. Upon waking from anesthesia. Patients commonly feel pain from the incision. The end of the duodenum will be stitched closed. The duodenum is clamped and separated from the bottom of the stomach.

They happen largely because the stomach. and a nasogastric tube in place. An operation called highly selective vagotomy is now preferred for ulcer management. Dumping syndrome is treated by adjusting the diet and pattern of eating. eating smaller. but it may result in a variety of postoperative complications. more frequent meals and limiting liquids. They cannot eat or drink immediately following surgery. In some cases.urinary catheter. sweating. the patient can drink clear liquids. If the liquids are tolerated. Risks Surgery for peptic ulcer is effective. The nasogastric tube is attached to intermittent suction to keep the stomach empty. heart palpitations or racing heart. for example. Following gastrectomy surgery. . oxygen is delivered through a mask that fits over the mouth and nose. as certain foods may now be difficult to digest. After a gastrectomy. which lessens acid production and slows stomach emptying." as food is rapidly dumped into the small intestine from the stomach. Dietary adjustments may be necessary. and then to more solid foods. the nasogastric tube is removed and the diet is gradually changed from liquids to soft foods. These procedures include vagotomy. as many as 30% of patients have significant symptoms. These may be symptoms of "dumping syndrome. the tube goes directly to the small intestine and remains in place until bowel function returns. When bowel sounds return. Some patients experience lightheadedness. and nausea and vomiting after a meal. which can take two to three days and is monitored by listening with a stethoscope for bowel sounds. and pyloroplasty . and is safer than gastrectomy. Other surgical procedures that often accompany gastrectomy for ulcer disease can also contribute to later symptoms. which serves as a food reservoir. which enlarges the opening between the stomach and small intestine to facilitate emptying of the stomach. several abnormalities may develop that produce symptoms related to food intake. A bowel movement is also a sign of healing. gastrectomy surgery usually requires a recuperation time of several weeks. If the whole stomach has been removed. Overall. has been reduced in its capacity by the surgery.

which is also surgically correctable. and vomiting may have bile reflux gastritis (also called bilious vomiting). Ulcers recur in a small percentage of patients after surgery for peptic ulcer. stimulating the release of insulin. Patients who have early satiety (feeling of fullness after eating). Others may lose weight and not enjoy meals as . iron. Vitamin D and calcium are also needed to prevent and treat the bone problems that often occur. The prognosis for patients with gastric lymphoma is better. For early gastric cancer. A high-protein diet and smaller meals are advised. Many patients will maintain a healthy appetite and eat a normal diet. with five-year survival rates reported at 40±60%. Most studies have shown that patients can have an acceptable quality of life after gastrectomy for a potentially curable gastric cancer. depending on the location of the tumor. Normal results Overall survival after gastrectomy for gastric cancer varies greatly by the stage of disease at the time of surgery.Patients who have abdominal bloating and pain after eating. the risk for spinal fractures may be as high as 50% after gastrectomy. Many patients also experience weight loss. frequently followed by nausea and vomiting. especially vitamin B 12 . occurring about two hours after eating. for late-stage disease. For gastric adenocarcinomas that are amenable to gastrectomy. and folate. Vitamin and mineral supplementation is necessary after gastrectomy to correct certain deficiencies." This is treated by surgical correction. the five-year survival rate is as high as 80±90%. According to one study. Reactive hypoglycemia is a condition that results when blood sugar levels become too high after a meal. Further surgery is usually necessary. may have what is called the "afferent loop syndrome. a loss of bone mass. the five-year survival rate is 10±30%. the prognosis is bad. abdominal discomfort. usually in the first few years. which can produce pain and osteoporosis. These include softening and bending of the bones.

There does not appear to be much difference. Purpose http://www. removal. Definition.much. recovery.surgeryencyclopedia. blood. complications. medication. the risk for postoperative death after gastrectomy for gastric cancer has been reported as 1±3% and the risk of non-fatal complications as 9±18%. Morbidity and mortality rates Depending on the extent of surgery. Read more: Gastrectomy . cancer. pain. heart. rate.com/FiLa/Gastrectomy. time.html#ixzz1Qj5VOcDw . in emotional status or social activity level between patients who have undergone total versus subtotal gastrectomies. nausea.procedure. however. gastric cancer incidence and mortality rates have been declining for several decades in most areas of the world. risk. operation. Some studies show that patients who have total gastrectomies have more diseaserelated or treatment-related symptoms after surgery and poorer physical function than patients who have subtotal gastrectomies. Overall. tube. adults.

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