Gastrectomy is a surgical intervention to remove part or all of the stomach. The stomach is a muscular sac located in the upper middle part of the abdomen, just below the ribs. The stomach receives the food that comes from the mouth through the esophagus, and then helps to break down and digest the ingested food.
A gastrectomy is a surgery of medium complexity and carries a moderate risk of complications.
Gastrectomy is performed primarily to treat stomach tumors and the complications they cause. Sometimes, although less and less frequently due to the use of treatment with “stomach protectors” such as omeprazole or ranitidine, it is indicated by presenting ulcers in your stomach.
Operations used for stomach cancer include the following:
- Removal of part of the stomach (subtotal gastrectomy). During subtotal gastrectomy, the surgeon removes the part of the stomach affected by cancer and some of the healthy tissue around it. This operation may be an option if your stomach cancer is located in the part of the stomach closest to the small intestine.
- Removal of the entire stomach (total gastrectomy). Total gastrectomy involves removal of the entire stomach and some of the tissue around it. The esophagus then connects directly to the small intestine to allow food to pass through the digestive system. Total gastrectomy is most often used for stomach cancer that affects the body of the stomach and that located at the gastroesophageal junction.
- Lymph node removal for cancer screening. The surgeon may remove some lymph nodes from your abdomen and test them for cancer.
- Surgery to relieve signs and symptoms. An operation to remove part of the stomach may relieve signs and symptoms of developing cancer in people with advanced stomach cancer.
Before any surgery, an assessment should be carried out by the anesthetist where they will advise you which medication you should stop taking and which you should continue taking. Sometimes you must be evaluated by another specialist if you have underlying diseases.
In the case of anticoagulant treatment or treatment that facilitates bleeding, the anesthesiologist, haematologist, cardiologist or family doctor will inform about the attitude to follow.
Normally you must be evaluated by Hematology before the intervention since they must draw blood to study your blood group and make a reserve of blood bags for the day of the intervention. In this surgery, bleeding is an important complication, so we must offer you maximum safety. For your peace of mind, most of our patients do not require a blood transfusion.
In the case of smoking, the habit should be stopped because it facilitates anesthetic management, smoker patients have more complications than smokers in anesthetic procedures.
It is recommended to perform moderate-intensity exercise before any intervention, unless there is a specific contraindication, such as walking at least 60 minutes a day.
How is the preparation prior to the intervention?
FOOD AND MEDICINE
In preparation for a gastrectomy, your surgeon may ask you to do the following:
- Do not eat anything before surgery. You can have a sip of water with your medications, but avoid eating and drinking for at least eight hours before surgery.
- Discontinue certain medications and supplements. Talk to your doctor about all medications and supplements you take. You continue to take most medications as directed by your doctor. Your doctor may ask you to stop certain medications and supplements because they can increase your risk of bleeding.
How is the surgery performed? (type of incision, resection, type of drainage, anesthesia)
BEFORE THE INTERVENTION
A gastrectomy is performed under general anesthesia, so you will not be conscious during the procedure. Numbing medications are given intravenously into the arm. Once the medications take effect, your health care team will insert a tube down your throat to help you breathe, place a catheter to monitor your urine, and place lines in your neck and wrist to administer drugs and learn about your heart function.
You may have an epidural catheter or injection into your spine, as well as local nerve blocks in your abdominal wall. These procedures allow you to recover with minimal pain and discomfort after surgery and help reduce the amount of opioid pain medication you’ll need.
Your surgeon will perform the gastrectomy using a laparoscopic or open procedure.
DURING THE PROCEDURE
Depending on your situation, your surgeon will recommend one of two surgical approaches:
Minimally invasive (laparoscopic) gastrectomy.
During a laparoscopic gastrectomy, the surgeon makes four to six small incisions in the abdomen. He inserts a tube with a tiny video camera into his abdomen through one of the incisions. The surgeon watches a video monitor in the operating room while using surgical tools inserted through the other incisions in the abdomen to remove the diseased part of the stomach or the entire stomach. Subsequently, a piece of small intestine must be attached to the part of the stomach that has remained or to the esophagus if the entire stomach has to be removed, to give continuity to the digestive tube.
One of the incisions will be enlarged to remove the removed stomach. The incisions are then sutured and you are moved to a recovery area. A laparoscopic gastrectomy takes between three and six hours.
A laparoscopic gastrectomy is not appropriate for everyone. In some cases, the surgeon may start with a laparoscopic approach and determine that a larger incision is necessary due to scar tissue from operations, previous complications, or an inability to safely continue with the procedure.
Traditional (open) gastrectomy
During an open gastrectomy, the surgeon makes an incision about 20 centimeters in the middle of the abdomen, above the navel. Muscle and tissue are retracted to reveal the liver. Next, the surgeon removes the diseased part of the stomach. Subsequently, the digestive tube will be continued through a union with the small intestine.
The incision is sutured and you are transferred to a post-anesthetic recovery area. An open gastrectomy takes between two and four hours. It is usually performed when the procedure cannot be carried out with maximum safety through the laparoscopic approach due to the complexity of the case.
Sometimes it is necessary to place a tube or drain inside the abdomen with an outlet through the skin to allow the discharge of fluid from the area where the diseased part of the liver was. This tube will be removed prior to discharge home.
What happens after the surgery?
After surgery, the patient is transferred to the Intensive Care Unit (ICU) where he will remain for 24 hours if there are no incidents. It is possible that the anesthesiologist will remove the connection to a breathing machine in the operating room or the doctor in charge of your surveillance in the ICU will do it. You will slowly wake up from the effects of the anesthetic drugs, so you may have a feeling of not remembering the process. After your stay in this unit you will then be transferred to your room.
HOW IS THE RECOVERY IN THE HOSPITAL?
It is possible to feel nausea or abdominal pain after the intervention but they will be controlled with the prescribed medication. After about 48 hours you will start with the intake of liquids and in the following days solid foods. We recommend sitting down and starting to walk about 24 hours after the intervention. The catheter that is inserted into your bladder will be removed in 1 or 2 days. At all times you will be supervised and helped by nursing staff.
If your surgery progresses on the floor without any incident, you will remain hospitalized for between 5 and 7 days.
HOW IS THE RECOVERY AT HOME?
Our premise is to be active in recovery. For this reason, we encourage the patient to walk daily, we recommend walking at least 60 minutes each day both inside and outside the house. Important physical efforts that may affect wound healing should always be avoided.
When you are discharged home, you will be prescribed medication to make you feel as comfortable as possible. You will resume your previous medication following the surgeon’s recommendations, since some drug may not be recommended in the first days after surgery. Normally the taking of painkillers is indicated to control the pain and the injection of heparin to avoid the appearance of thrombi in your legs.
In relation to food, we recommend the first two weeks to eat a soft diet, foods that are easy to digest. Subsequently, all types of food will be progressively reintroduced, with possible intolerance of some of them, so their intake will be suspended and they will be tried again in the following weeks.
You can wet your wounds when you wash yourself and then dry gently with the application of any antiseptic (chlorhexidine, povidone-iodine, crystalmine…). These wounds should be evaluated by nursing around 7 and 10 days after surgery.
Virtually complete recovery can take approximately three weeks in laparoscopic gastrectomy. However, with open gastrectomy, once at home, full recovery can take three to five weeks. It will depend on your physical condition before surgery and the complexity of the operation.
What are the risks of gastrectomy?
The normal thing is that your intervention proceeds without incidents but you must know the potential complications.
Less serious and frequent risks : Infection or bleeding of the surgical wound, phlebitis. Delayed recovery of intestinal motility. vomiting. Prolonged pain in the area of the operation.
Infrequent and serious risks : Dehiscence of the laparotomy (opening of the wound). Fistula or stenosis due to failure of the intestinal suture to heal. Alterations in nutritional status that are usually corrected with dietary supplements. Intra-abdominal bleeding or infection. Reproduction of the disease.
These complications are usually resolved with medical treatment (drugs, serums, etc.), but they may require a reoperation, usually an emergency, and in some cases death may occur.
Your risk of complications depends on your overall health and the reason you’re having a gastrectomy.