A gastrectomy is a major surgical procedure that involves removing either a portion or the entirety of the stomach. This operation becomes necessary when a serious medical condition compromises the stomach’s health, requiring the removal of the organ which functions primarily as a reservoir for food breakdown.
Types of Gastrectomy Procedures
The classification of a gastrectomy depends entirely on the anatomical extent of the removal. A Partial Gastrectomy, also known as subtotal gastrectomy, involves the removal of only the diseased part of the stomach, often the lower half or antrum. The remaining upper section of the stomach is then reconnected to the small intestine, allowing some of the organ’s storage function to continue.
A Total Gastrectomy is a more extensive operation, necessitating the complete removal of the entire stomach. In this case, the surgeon must connect the esophagus directly to the jejunum, the middle section of the small intestine. This connection creates a new pathway for food to enter the digestive tract, entirely bypassing the stomach.
A specialized type is the Sleeve Gastrectomy, which is most commonly performed as a bariatric, or weight-loss, surgery. This procedure involves removing a large vertical section of the stomach, leaving behind a narrow, tube-like gastric pouch. This reduction in stomach volume limits food intake and alters gut hormone production, contributing to weight loss and the improvement of related conditions.
Medical Conditions Requiring Gastrectomy
The primary indication for any type of gastrectomy is the treatment of cancer originating in the stomach. The extent of the cancer often dictates whether a partial or total gastrectomy is required, with advanced or widespread tumors typically necessitating complete removal of the organ. Nearby lymph nodes are also routinely removed during the operation to check for and prevent the spread of malignant cells.
Gastrectomy is also used as a measure of last resort for severe, non-cancerous conditions that have failed to respond to less invasive medical treatments. This includes peptic ulcers that have become complicated by life-threatening bleeding, perforation of the stomach wall, or obstruction. Chronic, refractory ulcers may require surgery to prevent further complications.
The sleeve gastrectomy is indicated for treating severe obesity, particularly in patients with a very high body mass index (BMI). This surgery can also have a profound effect on metabolic disorders, leading to significant improvement in conditions like type 2 diabetes and hypertension. The need for this surgery arises when obesity-related health risks outweigh the risks of the procedure itself.
Surgical Approaches and Techniques
Regardless of the extent of stomach removal, the surgery is performed using one of two main approaches: open or minimally invasive. An Open Gastrectomy involves a single, long incision down the abdomen, which provides the surgeon with a wide, direct view of the surgical field. This traditional method is often used for very advanced cancers or in complex cases that require extensive reconstruction.
The Minimally Invasive Gastrectomy is a modern approach that utilizes several small incisions, through which a camera and long, specialized instruments are inserted. This technique can be performed laparoscopically or with robotic assistance, offering the surgeon enhanced dexterity and visualization. Minimally invasive procedures are associated with several advantages, including less operative blood loss, reduced post-operative pain, and a faster recovery time.
Post-Operative Recovery
Patients remain hospitalized for several days for close monitoring and initial recovery. A nasogastric tube may be temporarily placed to remove fluids and air, while intravenous lines supply necessary fluids and nutrients until the digestive system begins to function again. The surgical team focuses on managing pain and encouraging early mobilization to prevent post-operative complications.
Life After Gastrectomy: Dietary and Digestive Adjustments
The most significant long-term consequence of a gastrectomy is the loss of the stomach’s reservoir function, which necessitates profound changes in eating habits. Patients must transition from eating three large meals a day to consuming six to eight smaller meals and snacks. The smaller capacity of the remaining digestive tract means that even a small amount of food can cause uncomfortable fullness.
Dumping Syndrome is a common side effect occurring when food, especially concentrated sugars, moves too quickly from the stomach remnant into the small intestine. This rapid transit causes the body to shift fluid into the intestine, leading to symptoms like cramping, diarrhea, and a rapid heart rate. To counteract this, patients must avoid simple sugars and separate liquid consumption from solid meals by waiting 30 to 60 minutes after eating before drinking.
Lifelong nutritional supplementation is required after gastrectomy because the removal of stomach tissue impairs the absorption of vital micronutrients. The stomach produces intrinsic factor, necessary for Vitamin B12 absorption, so patients must receive B12 injections or high-dose oral supplements. Decreased acid production also compromises the absorption of iron and calcium, making supplementation for these minerals and fat-soluble vitamins necessary to prevent anemia and bone density loss.