Definition and Overview
Also referred to as stomach resection, gastrectomy is the partial or complete removal of the stomach as part of or the main treatment of different conditions including obesity and stomach and esophageal cancer.
There are different types of gastrectomy that are performed depending on which part of the stomach is resected. It is referred to as sleeve gastrectomy if only the left side is removed and partial gastrectomy if only a part, including the area that is close to the duodenum, is removed. If the esophagus and the upper section of the stomach are removed, it is referred to as esophagogastrectomy.
In case the operation is complete, the surgeon will link a part of the bowel to the esophagus so the patient will retain his ability to digest food. However, the patient can expect major limitations since the stomach plays a huge role in breaking down food using its secreted gastric acid.
Who Should Undergo and Expected Results
Gastrectomy is recommended for patients with:
- Stomach cancer – This remains to be one of the primary reasons for gastrectomy. In cases where the condition has advanced, the procedure is combined with other types of treatment methods like chemotherapy. This type of cancer is associated with many risk factors, but it is mostly caused by the chronic inflammation due to a bacterium called H. pylori that irritates the stomach’s lining leading to pre-cancerous lesions in the area.
Gastrectomy tends to be very successful in patients diagnosed with an early-stage stomach cancer and the five-year survival rate can be as high as 90%. Since there are no available screening tests for stomach cancer, individuals can watch out for common signs and symptoms such as bloating, feeling of fullness despite a small appetite, unexplained weight loss, anemia, abdominal discomfort, and fluid buildup.
In certain situations, however, symptoms don’t often appear, especially if the cancer is due to a mutated CDH1 gene, which causes the stomach cancer cells to spread throughout the organ. Fortunately, this condition, which is attributed to 3% of gastric or stomach cancers, can be screened through regular biopsies.
Esophageal cancer that has spread to the upper section of the stomach. In this scenario, the entire esophagus is removed along with the diseased part of the stomach.
Peptic ulcers including duodenal and gastric ulcers. With these conditions, gastrectomy is often the last option if medications and dietary changes have failed to correct the conditions.
Gastrectomy has also been an alternative solution for patients who are morbidly obese, particularly if they already have or at a very high risk of serious diseases such as cardiovascular disorders and hypertension. For obesity, the procedure commonly done is sleeve gastrectomy as it can reduce the size of the stomach by about 75%, forcing the patient to eat significantly less food leading to drastic weight loss.
How Does the Procedure Work?
There are two ways to perform gastric resection: open and laparoscopic.
An open surgery, which is more ideal if a huge part or the entire stomach has to be resected, involves creating a large incision in the abdomen to access the stomach, keeping the incision wide open with a clamp. Using surgical instruments, the surgeon begins to remove the organ and follows it up with a reconstructive procedure.
During the reconstruction, the end of the duodenum, which is now open because of the missing stomach, is closed up while the part of the bowel that is next to the end of the duodenum is cut and straightened up to be connected to the esophagus. The end of the duodenum is then resected to the small bowel. In this manner, the bile will continue to drain into the duodenum.
On the other hand, laparoscopic surgery is a minimally invasive procedure that requires three to four small incisions in the abdomen. One of them is used to insert a laparoscope while the others are utilized for microsurgical instruments. This procedure is recommended if partial gastrectomy is to be performed.
In both approaches, the patient is administered general anaesthesia and advised to stay in the hospital for at least a week for close monitoring.
Possible Risks and Complications
A condition known as stomach dumping is a common complication of stomach resection and may occur within the first five hours after surgery. During this time, the body reacts negatively to the fast transition of food from the esophagus to the intestine. Some of the common signs include nausea, vomiting, diarrhea, and abdominal discomfort.
Other possible risks and complications include unintended weight loss, gallstone development due to significant weight loss, a leak in the intestine, infection and formation of abscess, bleeding, and appearance of blood clots.
- Mahvi DM, Krantz SB. Stomach. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 49.