A total gastrectomy is a major surgical procedure involving the complete removal of the stomach. This operation is considered when serious disease has compromised the entire organ beyond repair. Since the stomach temporarily stores food and initiates chemical digestion, its complete removal necessitates a substantial reconstruction of the gastrointestinal system and requires lifelong adjustments to eating and nutrition.
Medical Reasons for Removal
Total gastrectomy is reserved for highly aggressive conditions affecting the stomach. The most frequent indication is gastric cancer, especially when the tumor is large, involves the upper part of the stomach, or is spread throughout the lining. For stomach cancer, surgical removal offers the chance of cure and is often combined with chemotherapy or radiation therapy.
The procedure may also be necessary for high-risk precancerous conditions, such as diffuse familial polyposis. In rare instances, a total gastrectomy addresses severe, uncontrolled bleeding, complex obstructions, or irreparable trauma that cannot be managed by less extensive surgery. This operation is considered only when all other medical and surgical options have been ruled out.
The Surgical Process
The surgery begins with the removal of the entire stomach, often along with surrounding lymph nodes to check for disease spread. The surgeon disconnects the stomach from the esophagus above and the small intestine below. This step leaves a gap in the digestive system that must be surgically bridged.
Reconstruction is most often performed using a technique called Roux-en-Y esophagojejunostomy. In this procedure, the small intestine is divided, and a section of the jejunum is brought up to be directly connected to the esophagus. This connection allows food to pass straight from the esophagus into the small intestine.
The remaining portion of the small intestine, which carries digestive fluids from the liver and pancreas, is connected further down to the jejunum segment. This rerouting ensures that bile and digestive enzymes mix with food before it travels through the rest of the intestine, facilitating nutrient absorption. The surgery can be performed through a large incision (open surgery) or using a minimally invasive approach.
Immediate Postoperative Care
Immediately following the procedure, the patient is closely monitored for pain management and potential complications, such as bleeding or anastomotic leaks. The hospital stay typically lasts around seven to ten days, depending on recovery progress.
Nutritional reintroduction allows the new digestive connections to heal. Patients initially receive nutrition intravenously or through a feeding tube placed into the small bowel during surgery. Once healing is confirmed, the patient begins a clear liquid diet that progresses slowly to full liquids and then to soft, moist foods. This initial recovery phase focuses on high-protein intake to support healing and prevent rapid weight loss.
Nutritional and Lifestyle Changes
Living without a stomach requires dietary adjustments to accommodate the altered digestive anatomy. Since the stomach’s storage capacity is lost, patients must switch from three large meals to eating five to eight small, frequent meals or snacks. Consuming small portions helps prevent the small intestine from being overloaded, which causes discomfort and poor nutrient absorption.
Patients must also manage the risk of “dumping syndrome,” a common side effect where food passes too quickly into the small intestine. Symptoms include abdominal cramping, dizziness, and a rapid heart rate, especially after consuming sugary foods. To mitigate this, concentrated sweets are avoided, and liquids should be consumed at least 30 minutes before or after a meal, rather than with food.
The absence of the stomach means the body can no longer absorb Vitamin B12 from food because the intrinsic factor protein is no longer produced. Lifelong Vitamin B12 supplementation, usually by injection or high-dose oral supplements, is necessary to prevent anemia and neurological damage. Patients are also at a higher risk for deficiencies in other micronutrients, including iron, calcium, and Vitamin D, necessitating specialized, lifelong multivitamin supplementation.