Gastrectomy

What is a gastrectomy?

Gastrectomy is surgery to remove part or all of your stomach. The stomach is an important organ used for digestion. It is located in the upper part of your belly (abdomen). Food and liquid pass from your food pipe (esophagus) into your stomach. There they mix with digestive juices to break down the food.

Your surgeon may do this surgery to treat diseases of your stomach, such as cancer. It is also done to treat severe obesity. There are several types of gastrectomy. Total gastrectomy removes the whole stomach. Partial gastrectomy removes only a part of the stomach.

Your surgeon will usually do this surgery in the hospital. You will be given medicine (general anesthesia) to make you sleep and not feel any pain. Your surgeon will use one of two methods. The open surgery method uses one large cut (incision). The laparoscopic surgery method makes several small incisions. It uses a special tube (laparoscope) that has a camera and long, thin surgical tools.

Why might I need a gastrectomy?

Gastrectomy is the main treatment for stomach cancer. Other reasons for this surgery include:

• Noncancer stomach growths
• Stomach bleeding
• Stomach sores (ulcers)
• Severe obesity. The surgery for this is called bariatric surgery.

What are the risks of a gastrectomy?

Any time you have general anesthesia, there is a small risk of damaging your heart, lungs, or brain. Removing your stomach may decrease your ability to digest and absorb important nutrients in your diet. This can lead to vitamin deficiencies, anemia, and weak bones. Other risks include:

• Bleeding
• Blood clots
• Heartburn
• Hernia
• Infection
• Leaking of stomach contents
• Stomach pain after eating

Depending on your condition, you may have other risks. Discuss any concerns with your healthcare provider before the procedure.

How do I get ready for a gastrectomy?

• Your doctor will explain the procedure and ask if you have any questions.
• You will be asked to sign a consent form. This gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• In addition to a complete health history, your doctor may do a physical exam. This is to make sure you are in good health before having the procedure. You may have blood or other tests.
• Follow any directions you are given for not eating or drinking before the procedure.
• If you are pregnant or think you may be pregnant, tell your healthcare provider.
• Tell your provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or local and general anesthesia (anesthetic agents).
• Tell your doctor about all prescription and over-the-counter medicines you take. This includes vitamins, herbs, and supplements.
• Tell your doctor if you have a history of bleeding disorders. Also tell your doctor if you are taking any blood-thinning (anticoagulant) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.
• Based on your medical condition, your doctor may request other specific preparation.

• Follow any other instructions from your provider.

What happens during a gastrectomy?

A gastrectomy is done while you are asleep under general anesthesia. But your doctor will determine the type of anesthesia based on the reason for the procedure and your overall health status. Generally, a gastrectomy starts with this process:

1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.
2. You will be asked to remove clothing and be given a gown to wear.
3. An IV (intravenous) line will be inserted in your arm or hand.
4. A catheter may be inserted into the bladder to reduce the risk of tearing a hole in the bladder.
5. You will lie on your back on the operating table.
6. The anesthesiologist will check your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
7. If there is too much hair at the surgical site, it may be shaved off.
8. The skin over the surgical site will be cleaned with an antiseptic solution.

The rest of the procedure will depend on the type of gastrectomy to be done:

• Total gastrectomy. Your surgeon will make a cut (incision) in your upper belly (abdomen) and remove your stomach. Next, he or she will attach your esophagus to the upper part of your small intestine. If your surgeon is doing a total gastrectomy for stomach cancer, he or she may remove lymph nodes around your stomach.
• Partial gastrectomy. Your surgeon will do this procedure if only part of your stomach needs to be removed. He or she will make an incision that is similar to that of a total gastrectomy. He or she will attach the upper part of your stomach to the small intestine, with the location determined by the type of surgery. If you have cancer, your surgeon may also remove lymph nodes.
• Laparoscopic gastrectomy. Your surgeon may use this for either total or partial gastrectomy. He or she will remove your stomach through several small incisions. These incisions will be just big enough for the thin surgical tools to pass through. Laparoscopic surgery may not be used for advanced stomach cancer.
• Bariatric surgery. For obesity surgery, a sleeve gastrectomy is done. This removes much of the stomach. It creates a narrow tube that food will travel through. Gastric band surgery is another option. Discuss your options with your surgeon.

What happens after a gastrectomy?

After a gastrectomy, you will stay in the hospital for several days. You will most likely have a tube that runs through your nose and into your stomach. It will help to remove liquids and air. The tube will be removed once gas and fluids start moving through your digestive system. An IV tube will remain in your vein. This will provide you with fluids and nutrition until you can start eating. You will be given pain medicine, along with other medicines, depending on your condition. Hospital staff will help you walk, and provide wound care and bathroom care.

After you go home, follow all your healthcare provider’s instructions and keep your follow-up appointments. Instructions for home care may include:

• Limit activity until your provider says it’s OK.
• Eat smaller, more frequent meals.
• Take vitamin supplements.
• Watch your incision for any signs of redness, swelling, bleeding, or leaking.

Full recovery after a gastrectomy may take several weeks.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much will you have to pay for the test or procedure