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Gastrectomy

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(Total Gastrectomy; Partial Gastrectomy; Subtotal Gastrectomy; Stomach Removal)

Definition

This is a surgery to remove all or part of the stomach.
Abdominal Organs, Anterior View
gastro intestinal stomach
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Reasons for Procedure

Gastrectomy is most often done to treat stomach cancer . It is currently the only way to cure stomach cancer. The use of chemotherapy and radiation after surgery may help improve survival. Even if the cancer is too advanced to be cured, gastrectomy can help to prevent bleeding, obstruction, and pain.
In addition to treating stomach cancer, this surgery may also be done to treat:
  • Ulcer disease
  • Bleeding
  • Inflammation
  • Benign tumors in the stomach

Possible Complications

If you are planning to have gastrectomy, your doctor will review a list of possible complications, which may include:
  • Damage to nearby organs
  • Leaking from the new connection between the stomach, intestine, and/or esophagus
  • Infection
  • Bleeding
  • Hernia formation at the incision site
  • Blood clots
  • Reaction to anesthesia
Factors that may increase the risk of complications include:
  • Obesity
  • Advanced age
  • Smoking
  • Poor nutritional status
  • Respiratory disease or cardiac disease
Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure

Your doctor may do the following:
  • Physical exam
  • Blood tests
  • Fecal occult blood test (FOBT)—a test to check for blood in the stool
  • Endoscopy—a procedure that uses a scope with a camera on the end to examine the gastrointestinal system
  • Upper GI series —a series of x-rays of the esophagus, stomach, and intestine during and after drinking a barium solution
  • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
Leading up to your procedure:
  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin )
    • Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
  • Your doctor may recommend:
    • Eating a special diet
    • Taking antibiotics
    • Showering the night before your surgery using antibacterial soap
  • Arrange to have someone drive you to and from the hospital. Also, arrange for someone to help you at home.
  • Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

Description of the Procedure

The doctor will make an incision in your abdomen. Next, she will use surgical instruments to remove all or part of your stomach. If only part of your stomach is removed, it is called partial gastrectomy. With this type of surgery, the doctor will connect the remaining part of your stomach to your esophagus and small intestine. If this is done for ulcer disease, the nerves that control acid production may also be cut. If all of your stomach is removed, it is called total gastrectomy. The doctor will attempt to make a new “stomach” using your intestinal tissue. The end of your esophagus will be attached to your small intestine.
If you have stomach cancer, the doctor will likely remove and examine lymph nodes as well. This is because cancer can spread through your lymphatic system.
After the surgery is complete, the doctor will close the muscles and skin of the abdomen with stitches or staples. Lastly, she will apply a dressing.

How Long Will It Take?

1-3 hours (or longer)

How Much Will It Hurt?

You will have pain during recovery. Ask your doctor about medicine to help with the pain.

Average Hospital Stay

This surgery is done in a hospital setting. The usual length of stay is 6-12 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

Your doctor will give you guidelines on:
  • When and what you can eat
  • How you need to restrict your activity
Ask your doctor about when it is safe to shower, bathe, or soak in water.
During the first few days after surgery, you may be restricted from eating. As your stomach stretches during recovery, you will be able to eat more at a time. If you had a total gastrectomy, you will need to eat smaller amounts of foods more often.
After surgery, you may experience:
  • Frequent heartburn
  • Abdominal pain
  • Vitamin deficiencies
To treat these symptoms, your doctor will:
  • Prescribe medicines and vitamin supplements
  • Make changes in your diet
Be sure to follow your doctor's instructions .

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Pain that you cannot control with the medicines you have been given
  • Pain and/or swelling in your feet, calves, or legs
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
  • Cough, shortness of breath, or chest pain
  • Swelling and/or pain in your legs, calves, or feet
In case of an emergency, call for medical help right away.

RESOURCES

American Cancer Society http://www.cancer.org/

American Gastroenterological Association http://www.gastro.org/

National Cancer Institute http://www.cancer.gov/

CANADIAN RESOURCES

BC Cancer Agency http://www.bccancer.bc.ca/default.htm/

Canadian Cancer Society http://www.cancer.ca/

References

Stomach and esophageal cancer: what treatments are available? The Cancer Council Victoria website. Available at: http://www.cancervic.org.au/cancer1/patients/stomach/whattreatments.htm . Updated February 2008. Accessed September 3, 2009.

Stomach cancer: surgery. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI%5F2%5F4%5F4X%5FSurgery%5F40.asp?sitearea= . Updated May 2009. Accessed September 3, 2009.

Surgery to remove stomach cancer. Cancer Research UK website. Available at: http://www.cancerhelp.org.uk/help/default.asp?page=3917 . Updated December 2008. Accessed September 3, 2009.

What you need to know about stomach cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/wyntk/stomach/ . Published August 2005. Accessed September 3, 2009.

Revision Information

  • Reviewer: Daus Mahnke, MD
  • Review Date: 11/2012 -
  • Update Date: 11/26/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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