Overview
Gastrectomy is the surgical removal of all or part of the stomach. This surgery is performed as a treatment for stomach cancer and may also be indicated for a bleeding gastric ulcer, a perforation (hole) in the stomach wall, and noncancerous polyps.
The stomach plays such a large role in digestion, that it may be hard to believe that this organ can be removed. Yet, a person can adjust to living without a stomach.
The stomach connects to the esophagus (tube that carries food from the mouth) on one end and the small intestine (primary site of nutrient absorption) on the other end. When part of the
stomach is removed, the remaining portion continues its digestive function. If the entire stomach is removed, the esophagus is attached to the small intestine, the digestive process begins in the small intestine, and the body eventually adapts. Dietary changes may be necessary.
Surgical Procedure General anesthesia is used to render the patient unconscious, so they do not experience pain and have no awareness during the operation. When the anesthesia has taken effect, a urinary catheter is usually inserted to monitor urine output. A nasogastric tube (i.e., a thin tube from the nose down into the stomach) is also put in. The abdomen is then cleansed with an antiseptic solution.
The surgeon makes a large incision from just below the breastbone to the navel. If the lower end of the stomach is diseased, the surgeon places clamps on either end of the area and that portion of the stomach is removed. The upper part of the stomach is then attached to the small intestine.
If the upper end of the stomach is diseased, the end of the esophagus and the upper part of the stomach are clamped. The affected portion is removed, and the lower part of the stomach is attached to the esophagus.
In a total gastrectomy, clamps are placed on the end of the esophagus and the end of the small intestine. The stomach is removed and the esophagus is joined to the intestine. Lymph nodes, a section of the pancreas, and the spleen are often removed in cases of cancer.
The abdomen is sutured. The nasogastric tube remains in place and is removed during the postoperative period. Surgery generally takes between 1 and 3 hours, depending on the diagnosis and the extent of the disease.
Preoperative Care Prior to surgery, patients undergo preoperative testing, which may include x-rays, CT scans, ultrasonography, blood tests, urinalysis, and an EKG.
Medications that "thin" the blood , such as aspirin, are discontinued several days prior to the operation. Other
drugs, such as insulin for diabetes, may be withheld the day of surgery. As soon as the decision to undergo surgery is made, medication usage should be discussed with the physician.
The stomach must be completely empty before the operation begins to avoid vomiting that can occur during the procedure. Patients must abstain from solid food and liquid after midnight on the evening before the operation.
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