It is possible for individuals to live without their stomach. While the stomach plays a significant role in digestion, its complete or partial removal, known as a gastrectomy, allows the body to adapt and continue the digestive process. This medical intervention necessitates substantial lifestyle adjustments and ongoing medical management to maintain health and well-being.
Medical Reasons for Stomach Removal
Gastrectomy is a surgical procedure performed to remove all or part of the stomach, typically when other treatments prove insufficient. Stomach cancer is the most frequent reason for this surgery, as removing cancerous tissue can be life-saving or prevent further spread. In such cases, surrounding lymph nodes may also be removed to check for cancer dissemination.
Beyond cancer, severe peptic ulcer disease that has not responded to medications or lifestyle changes can also necessitate a gastrectomy. Uncontrolled gastric bleeding or severe inflammation of the stomach lining (gastritis) are other conditions that may lead to this surgery as a last resort. In some instances, a partial gastrectomy may be performed as a bariatric (weight loss) surgery for individuals with severe obesity that poses significant health risks. Additionally, stomach removal may be required due to severe trauma or to prevent hereditary diffuse stomach cancer in individuals with a specific gene mutation (CDH1).
How Gastrectomy is Performed
Gastrectomy involves surgically removing part or all of the stomach. A partial gastrectomy entails the removal of a section, often the lower half, with the remaining part connected to the small intestine. For instance, a subtotal gastrectomy removes about 80% of the stomach. Conversely, a total gastrectomy involves the complete removal of the stomach, directly connecting the esophagus to the small intestine.
The surgical approach can vary, with surgeons performing either open surgery through a single large incision or minimally invasive laparoscopic techniques using several small incisions and a camera. Regardless of the technique, the goal is to reconstruct the digestive system to allow for continued nourishment. The operation typically lasts between 3 and 8 hours, depending on the extent of the removal. Immediately following surgery, patients cannot eat or drink and receive fluids and nutrition intravenously or through a feeding tube, which allows the newly connected digestive parts to heal. Patients usually remain in the hospital for 1 to 2 weeks for initial recovery.
Life After Stomach Removal
Life after a gastrectomy involves significant adjustments to the digestive process and daily habits. Without the stomach, the body loses its primary food reservoir, its ability to grind food into a purée, and its capacity to produce stomach acid and intrinsic factor, which are important for nutrient absorption. The small intestine assumes a more prominent role in digestion and nutrient absorption, though its efficiency may be reduced.
Dietary changes are paramount, requiring individuals to eat small, frequent meals, typically 6 to 8 times a day, rather than three large ones. Thoroughly chewing food into a very soft or pureed consistency is highly recommended to aid digestion, as the initial mechanical breakdown by the stomach is absent. Drinking liquids should be separated from meals, usually 30 to 60 minutes before or after eating, to prevent feeling overly full too quickly. Foods high in added sugars or excessive fats should be limited, as they can trigger complications.
One common challenge is Dumping Syndrome, which occurs when food moves too rapidly from the esophagus or remaining stomach into the small intestine. Early dumping, occurring within 30 minutes of eating, can cause symptoms like nausea, cramping, dizziness, and a rapid heart rate due to fluid shifts into the intestine. Late dumping, occurring 1 to 3 hours after eating, is often linked to a rapid spike and subsequent drop in blood sugar, leading to weakness, sweating, shakiness, and confusion. Managing Dumping Syndrome involves dietary modifications such as avoiding simple sugars, increasing protein and healthy fats, and incorporating fiber-rich foods to slow digestion.
Individuals also face a higher risk of nutrient deficiencies, particularly for Vitamin B12, iron, calcium, and fat-soluble vitamins (A, D, E, K). This is because the stomach’s removal impacts the production of intrinsic factor for B12 absorption and stomach acid for iron and calcium dissolution, and can bypass primary absorption sites in the small intestine. Lifelong supplementation, often including monthly Vitamin B12 injections or specially formulated bariatric vitamins, is generally necessary. Regular follow-up appointments with healthcare providers, ongoing dietary counseling, and routine blood tests are essential to monitor nutrient levels and address any emerging issues, ensuring a healthy long-term outlook.