Gastrectomy - Stomach Removal - Healthgrades.com ADVERTISEMENT What is a gastrectomy? A gastrectomy is the surgical removal of part or all of the stomach. Your doctor may recommend a gastrectomy to treat cancer, benign tumors, severe ulcers, and other conditions that damage the stomach. Your doctor may perform a gastrectomy for some ulcers of the small intestine just after your stomach. Some types of bariatric surgery (weight-loss surgery) include a gastrectomy. Gastrectomy is a major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a gastrectomy. Types of gastrectomy The types of gastrectomy procedures include: Partial gastrectomy is the removal of part of the stomach. Your doctor attaches your small intestine to the remaining healthy part of the stomach. Total gastrectomy is the removal of the entire stomach. Your doctor attaches the small intestine to the esophagus. Sleeve gastrectomy (also called vertical sleeve gastrectomy and stomach stapling) is the removal of a large part of the stomach to help with weight loss.

Your doctor uses staples to create a smaller stomach and attaches the small intestine to the remaining stomach. Gastrectomy - procedure, recovery, blood, tube, removal, pain, complications, adults Gastrectomy Gastrectomy is the surgical removal of all or part of the stomach. Purpose Gastrectomy is performed most commonly to treat the following conditions: stomach cancer perforation of the stomach wall noncancerous polyps Demographics Stomach cancer was the most common form of cancer worldwide in the 1970s and early 1980s, and the incidence rates have always shown substantial variation in different countries. Rates are currently highest in Japan and eastern Asia, but other areas of the world have high incidence rates, including Eastern European countries and parts of Latin America. Incidence rates are generally lower in Western Europe and the United States. Gastrointestinal diseases (including gastric ulcers) affect an estimated 25–30% of the world's population. In the United States, 60 million adults experience gastrointestinal reflux at least once a month, and 25 million adults suffer daily from heartburn, a condition that may evolve into ulcers.

Description Gastrectomy for cancer Removal of the tumor, often with removal of the surrounding lymph nodes, is the only curative treatment for various forms of gastric (stomach) cancer. For many patients, this entails removing not only the tumor, but part of the stomach as well. The extent to which lymph nodes should also be removed is a subject of debate, but some studies show additional survival benefits associated with removal of a greater number of lymph nodes. Gastrectomy, either total or subtotal (also called partial), is the treatment of choice for gastric adenocarcinomas, primary gastric lymphomas (originating in the stomach), and the rare leiomyosarcomas (also called gastric sarcomas). Adenocarcinomas are by far the most common form of stomach cancer and are less curable than the relatively uncommon lymphomas, for which gastrectomy offers good chances of survival. General anesthesia is used to ensure that the patient does not experience pain and is not conscious during the operation. When the anesthesia has taken hold, a urinary catheter is usually inserted to monitor urine output. A thin nasogastric tube is inserted from the nose down into the stomach. The abdomen is cleansed with an antiseptic solution.

The surgeon makes a large incision from just below the breastbone down to the navel. If the lower end of the stomach is diseased, the surgeon places clamps on either end of the area, and that portion is excised. The upper part of the stomach is then attached to the small intestine. If the upper end of the stomach is diseased, the end of the esophagus and the upper part of the stomach are clamped together. The diseased part is removed, and the lower part of the stomach is attached to the esophagus. After gastrectomy, the surgeon may reconstruct the altered portions of the digestive tract so that it may continue to function. Several different surgical techniques are used, but, generally speaking, the surgeon attaches any remaining portion of the stomach to the small intestine. Gastrectomy for gastric cancer is almost always done using the traditional open surgery technique, which requires a wide incision to open the abdomen. However, some surgeons use a laparoscopic technique that requires only a small incision. The laparoscope is connected to a tiny video camera that projects a picture of the abdominal contents onto a monitor for the surgeon's viewing. The stomach is operated on through this incision.

The potential benefits of laparoscopic surgery include less postoperative pain, decreased hospitalization, and earlier return to normal activities. The use of laparoscopic gastrectomy is limited, however. Only patients with early-stage gastric cancers or those whose surgery is intended only for palliation (pain and symptomatic relief rather than cure) are considered for this minimally invasive technique. It can only be performed by surgeons experienced in this type of surgery. Gastrectomy for ulcers Gastrectomy is also occasionally used in the treatment of severe peptic ulcer disease or its complications. While the vast majority of peptic ulcers (gastric ulcers in the stomach or duodenal ulcers in the duodenum) are managed with medication, partial gastrectomy is sometimes required for peptic ulcer patients who have complications. These include patients who do not respond satisfactorily to medical therapy; those who develop a bleeding or perforated ulcer; and those who develop pyloric obstruction, a blockage to the exit from the stomach. The surgical procedure for severe ulcer disease is also called an antrectomy , a limited form of gastrectomy in which the antrum, a portion of the stomach, is removed.

For duodenal ulcers, antrectomy may be combined with other surgical procedures that are aimed at reducing the secretion of gastric acid, which is associated with ulcer formation. This additional surgery is commonly a vagotomy , surgery on the vagus nerve that disables the acid-producing portion of the stomach. Diagnosis/Preparation Before undergoing gastrectomy, patients require a variety of such tests as x rays, computed tomography (CT) scans, ultrasonography, or endoscopic biopsies (microscopic examination of tissue) to confirm the diagnosis and localize the tumor or ulcer. Laparoscopy may be done to diagnose a malignancy or to determine the extent of a tumor that is already diagnosed. When a tumor is strongly suspected, laparoscopy is often performed immediately before the surgery to remove the tumor; this method avoids the need to anesthetize the patient twice and sometimes avoids the need for surgery altogether if the tumor found on laparoscopy is deemed inoperable. Aftercare After gastrectomy surgery, patients are taken to the recovery unit and vital signs are closely monitored by To remove a portion of the stomach in a gastrectomy, the surgeon gains access to the stomach via an incision in the abdomen.

The ligaments connecting the stomach to the spleen and colon are severed (B). The duodenum is clamped and separated from the bottom of the stomach, or pylorus (C). The end of the duodenum will be stitched closed. The stomach itself is clamped, and the portion to be removed is severed (D). The remaining stomach is attached to the jejunum, another portion of the small intestine (E). ( Illustration by GGS Inc. ) the nursing staff until the anesthesia wears off. Patients commonly feel pain from the incision, and pain medication is prescribed to provide relief, usually delivered intravenously. Upon waking from anesthesia, patients have an intravenous line, a urinary catheter, and a nasogastric tube in place. They cannot eat or drink immediately following surgery. In some cases, oxygen is delivered through a mask that fits over the mouth and nose. The nasogastric tube is attached to intermittent suction to keep the stomach empty. If the whole stomach has been removed, the tube goes directly to the small intestine and remains in place until bowel function returns, which can take two to three days and is monitored by listening with a stethoscope for bowel sounds.

A bowel movement is also a sign of healing. When bowel sounds return, the patient can drink clear liquids. If the liquids are tolerated, the nasogastric tube is removed and the diet is gradually changed from liquids to soft foods, and then to more solid foods. Dietary adjustments may be necessary, as certain foods may now be difficult to digest. Overall, gastrectomy surgery usually requires a recuperation time of several weeks. Risks Surgery for peptic ulcer is effective, but it may result in a variety of postoperative complications. Following gastrectomy surgery, as many as 30% of patients have significant symptoms. An operation called highly selective vagotomy is now preferred for ulcer management, and is safer than gastrectomy. After a gastrectomy, several abnormalities may develop that produce symptoms related to food intake. They happen largely because the stomach, which serves as a food reservoir, has been reduced in its capacity by the surgery. Other surgical procedures that often accompany gastrectomy for ulcer disease can also contribute to later symptoms. These procedures include vagotomy, which lessens acid production and slows stomach emptying; and pyloroplasty , which enlarges the opening between the stomach and small intestine to facilitate emptying of the stomach.

Some patients experience lightheadedness, heart palpitations or racing heart, sweating, and nausea and vomiting after a meal. These may be symptoms of "dumping syndrome," as food is rapidly dumped into the small intestine from the stomach. Dumping syndrome is treated by adjusting the diet and pattern of eating, for example, eating smaller, more frequent meals and limiting liquids. Patients who have abdominal bloating and pain after eating, frequently followed by nausea and vomiting, may have what is called the "afferent loop syndrome." This is treated by surgical correction. Patients who have early satiety (feeling of fullness after eating), abdominal discomfort, and vomiting may have bile reflux gastritis (also called bilious vomiting), which is also surgically correctable. Many patients also experience weight loss. Reactive hypoglycemia is a condition that results when blood sugar levels become too high after a meal, stimulating the release of insulin, occurring about two hours after eating. A high-protein diet and smaller meals are advised. Ulcers recur in a small percentage of patients after surgery for peptic ulcer, usually in the first few years. Further surgery is usually necessary.

Vitamin and mineral supplementation is necessary after gastrectomy to correct certain deficiencies, especially vitamin B 12 , iron, and folate. Vitamin D and calcium are also needed to prevent and treat the bone problems that often occur. These include softening and bending of the bones, which can produce pain and osteoporosis, a loss of bone mass. According to one study, the risk for spinal fractures may be as high as 50% after gastrectomy. Normal results Overall survival after gastrectomy for gastric cancer varies greatly by the stage of disease at the time of surgery. For early gastric cancer, the five-year survival rate is as high as 80–90%; for late-stage disease, the prognosis is bad. For gastric adenocarcinomas that are amenable to gastrectomy, the five-year survival rate is 10–30%, depending on the location of the tumor. The prognosis for patients with gastric lymphoma is better, with five-year survival rates reported at 40–60%. Most studies have shown that patients can have an acceptable quality of life after gastrectomy for a potentially curable gastric cancer. Many patients will maintain a healthy appetite and eat a normal diet.

Others may lose weight and not enjoy meals as much. Some studies show that patients who have total gastrectomies have more disease-related or treatment-related symptoms after surgery and poorer physical function than patients who have subtotal gastrectomies. There does not appear to be much difference, however, in emotional status or social activity level between patients who have undergone total versus subtotal gastrectomies. Morbidity and mortality rates Depending on the extent of surgery, the risk for postoperative death after gastrectomy for gastric cancer has been reported as 1–3% and the risk of non-fatal complications as 9–18%. Overall, gastric cancer incidence and mortality rates have been declining for several decades in most areas of the world. Resources books "Disorders of the Stomach and Duodenum." In The Merck Manual. Whitehouse Station, NJ: Merck & Co., Inc., 1992. "Stomach and Duodenum: Complications of Surgery for Peptic Ulcer Disease." In Sleisenger & Fordtran's Gastrointestinal and Liver Disease, edited by Mark Feldman et al. Philadelphia: W. B. Saunders Co., 1998.

periodicals Fujiwara, M., et al. "Laparoscopy-Assisted Distal Gastrectomy with Systemic Lymph Node Dissection for Early Gastric Carcinoma: A Review of 43 Cases." Journal of the American College of Surgeons 196 (January 2003): 75–81. Iseki, J., et al. "Feasibility of Central Gastrectomy for Gastric Cancer." Surgery 133 (January 2003): 75–81. Kim, Y. W., H. S. Han, and G. D. Fleischer. "Hand-Assisted Laparoscopic Total Gastrectomy." Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 13 (February 2003): 26–30. Kono, K., et al. "Improved Quality of Life with Jejunal Pouch Reconstruction after Total Gastrectomy." American Journal of Surgery 185 (February 2003): 150–154.

organizations Monique Laberge, PhD WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED? A gastrectomy is performed by a surgeon trained in gastroenterology, the branch of medicine that deals with the diseases of the digestive tract. An anesthesiologist is responsible for administering anesthesia, and the operation is performed in a hospital setting. QUESTIONS TO ASK THE DOCTOR What happens on the day of surgery? What type of anesthesia will be used? How long will it take to recover from the surgery? When can I expect to return to work and/or resume normal activities? What are the risks associated with a gastrectomy? How many gastrectomies do you perform in a year? Will there be a scar? Also read article about Gastrectomy from Wikipedia User Contributions: Stomach, Gallbladder and Pancreas | Interactive Anatomy Guide Home > Digestive System > Digestive System of the Lower Torso > Stomach, Gallbladder and Pancreas Stomach, Gallbladder and Pancreas The stomach, gallbladder, and pancreas are three of the most important digestive organs in the human body.

These organs work together to produce and store secretions that digest our food into its most basic building blocks. Once digested, these small molecules pass into our intestines to be absorbed and to feed our body’s tissues. These three major organs also produce hormones that help to coordinate their functions and even lead to the feeling of fullness after consuming a meal.... Move up/down/left/right: Click compass arrows Rotate image: Click and drag in any direction, anywhere in the frame Identify objects: Click on them in the image Full Stomach, Gallbladder and Pancreas Description [Continued from above] . . . Anatomy of the Stomach, Gallbladder, and Pancreas Stomach A hollow muscular organ about the size of 2 closed fists, the stomach is located inferior to the diaphragm and lateral to the liver on the left side of the abdominal cavity. The stomach forms part of the gastrointestinal tract between the esophagus and the duodenum (the first section of the small intestine). The wall of the stomach contains several layers of epithelium, smooth muscle, nerves, and blood vessels. The innermost layer of the stomach is made of epithelium containing many invaginations known as gastric pits.

The cells of the gastric pits produce gastric juice - an acidic mixture of mucus, enzymes and hydrochloric acid. The hollow portion of the stomach serves as the storage vessel for food before it moves on to the intestines to be further digested and absorbed. At the inferior end of the stomach is a band of smooth muscle called the pyloric sphincter. The pyloric sphincter opens and closes to regulate the flow of food into the duodenum. Gallbladder The gallbladder is a 3-inch long pear-shaped sac located on the posterior border of the liver. Connected to the bile ducts of the liver through the cystic duct , the gallbladder receives bile transported from the liver for storage on a regular basis to prepare for the digestion of future meals. During digestion of a meal, smooth muscles in the walls of the gallbladder contract to push bile into the bile ducts that lead to the duodenum. Once in the duodenum, bile helps with the digestion of fats. Pancreas The pancreas is a 6-inch long heterocrine gland located inferior to the stomach and surrounded by the duodenum on its medial end.

This organ extends laterally from the duodenum toward the left side of the abdominal cavity, where it tapers to a point. The pancreas is considered a heterocrine gland because it has both endocrine and exocrine gland functions. Small masses of endocrine cells known as pancreatic islets make up around 1% of the pancreas and produce the hormones insulin and glucagon to regulate glucose homeostasis in the blood stream. The other 99% of the pancreas contains exocrine cells that produce powerful enzymes that are excreted into the duodenum during digestion. These enzymes together with water and sodium bicarbonate secreted from the pancreas are known as pancreatic juice. Physiology of the Stomach, Gallbladder, and Pancreas Digestion The stomach, gallbladder, and pancreas work together as a team to perform the majority of the digestion of food. Food entering the stomach from the esophagus has been minimally processed – it has been physically digested by chewing and moistened by saliva, but is chemically almost identical to unchewed food.

Upon entering the stomach, each mass of swallowed food comes into contact with the acidic gastric juice, which contains hydrochloric acid and the protein-digesting enzyme pepsin. These chemicals begin working on the chemical digestion of the molecules that make up the food. At the same time, the food is mixed by the smooth muscles of the stomach wall to increase the amount of contact between the food and the gastric juice. The secretions of the stomach also continue the process of moistening and physically softening the food until the food becomes an acidic semi-liquid material known as chyme. At this point, the stomach begins to push the chyme through the pyloric sphincter and into the duodenum. In the duodenum , the bulk of digestion is completed thanks to the preparation of chyme by the stomach and the addition of secretions from the gallbladder and pancreas. Bile from the gallbladder acts as an emulsifier to break large masses of fats into smaller masses. Pancreatic juice contains bicarbonate ions to neutralize the hydrochloric acid of chyme. Enzymes present in the pancreatic juice complete the chemical digestion of large molecules that began in the mouth and stomach.

The completely digested food is then ready for absorption by the intestines . Storage The stomach, gallbladder, and pancreas all function together as storage organs of the digestive system. The stomach stores food that has been ingested and releases it in small masses to the duodenum. The release of small masses of food at a time improves the digestive efficiency of the intestines, liver, gallbladder, and pancreas and prevents undigested food from making its way into feces. As they are accessory organs of the digestive system, the gallbladder and pancreas have no food passing through them. They do, however, act as storage organs by storing the chemicals necessary for the chemical digestion of foods. The gallbladder stores bile produced by the liver so that there is a sufficient supply of bile on hand to digest fats at any given time. The pancreas stores the pancreatic juice produced by its own exocrine glands so that it is prepared to digest foods at all times. Secretion The stomach, gallbladder, and pancreas all share the common function of secretion of substances from exocrine glands. The stomach contains 3 different exocrine cells inside of its gastric pits: mucous cells, parietal cells, and chief cells.

Mucous cells produce mucus and bicarbonate ion that cover the surface of the stomach lining, protecting the underlying cells from the damaging effects of hydrochloric acid and digestive enzymes. Parietal cells produce hydrochloric acid to digest foods and kill pathogens that enter the body through the mouth. Chief cells produce the protein pepsinogen that is turned into the enzyme pepsin when it comes into contact with hydrochloric acid. Pepsin digests proteins into their component amino acids. The mixture of mucus, hydrochloric acid, and pepsin is known as gastric juice. Gastric juice mixes with food to produce chyme, which the stomach releases into the duodenum for further digestion. The gallbladder stores and secretes bile into the duodenum to aid in the digestion of chyme. A mixture of water, bile salts, cholesterol, and bilirubin, bile emulsifies large masses of fats into smaller masses. These smaller masses have a higher ratio of surface area to volume when compared to large masses, making it easier for them to be digested. The pancreas stores and secretes pancreatic juice into the duodenum to complete the chemical digestion of food that began in the mouth and stomach.

Pancreatic juice contains a mixture of enzymes including amylases, proteases, lipases, and nucleases. Carbohydrates entering the small intestine are broken down into monosaccharides by enzymes such as pancreatic amylase, maltase, and lactase. Proteins in the duodenum are chemically digested into amino acids by pancreatic enzymes such as trypsin and carboxypeptidase. Pancreatic lipase breaks triglycerides into fatty acids and monoglycerides. The nucleic acids DNA and RNA are broken down by nucleases into their component sugars and nitrogenous bases. Hormones Several hormones are used to regulate the functions of the stomach, gallbladder, and pancreas. The hormones gastrin, cholecystokinin, and secretin are secreted by organs of the digestive system in response to the presence of food and change the function of the stomach, gallbladder, and pancreas. Our pancreas produces the hormones insulin and glucagon to affect the behavior of cells throughout the body. Gastrin is a hormone produced by the walls of the stomach in response to the filling of the stomach with food. Food stretches the stomach walls and raises the normally acidic pH of the stomach.

G cells in the gastric glands of the stomach respond to these changes by producing gastrin. G cells release gastrin into the blood where it stimulates the exocrine cells of the stomach to produce gastric juice. Gastrin also stimulates smooth muscle tissue of the gastrointestinal tract to increase the mixing and movement of food. Finally, gastrin relaxes the smooth muscles that form the pyloric sphincter, causing the pyloric sphincter to open. The opening of the pyloric sphincter allows food stored in the stomach to begin entering the duodenum for further digestion and absorption in the intestines. Cholecystokinin (CCK), a hormone produced in the walls of the small intestine , is released into the bloodstream in response to the presence of chyme in the intestine that contains high levels of proteins and fats. Proteins and fats are more difficult for the body to digest than carbohydrates are, so CCK is important in making changes to the digestive system to handle these types of foods. CCK travels through the bloodstream to the stomach, where it slows the emptying of the stomach to give the intestines more time to digest the protein- and fat-rich chyme.

CCK also stimulates the gallbladder and pancreas to increase their secretion of bile and pancreatic juice to improve the digestion of fats and proteins. Finally, CCK is detected by receptors in the satiety center of the hypothalamus that control the feeling of hunger. The satiety center reads the presence of CCK as an indication that the body is no longer hungry for food. Secretin is another hormone produced by the intestinal walls, but unlike CCK, it is produced in response to the acidity of chyme that the stomach releases into the duodenum. Secretin flows through the bloodstream to the stomach, where it inhibits the production of hydrochloric acid by parietal cells. Secretin also binds to receptors in the gallbladder and pancreas, stimulating them to secrete increased amounts of bile and pancreatic juice. Sodium bicarbonate present in pancreatic juice neutralizes the acidity of the chyme to prevent damage to the walls of the duodenum and provides a neutral pH environment for the digestion of chyme. Insulin is a hormone produced by the beta cells of the pancreatic islets of the pancreas. The pancreas produces insulin in response to the presence of high levels of glucose in the blood.

Insulin stimulates cells, particularly in the liver and skeletal muscles , to absorb glucose from the blood and use it as an energy source or store it as glycogen. Insulin also stimulates adipocytes to absorb glucose to build triglycerides for energy storage. Our body produces higher levels of insulin following a meal in order to remove glucose molecules from the blood before they can reach high concentrations and become toxic to the body’s cells. Glucagon is a hormone produced by the alpha cells of the pancreatic islets of the pancreas. Glucagon acts as an antagonist to insulin by stimulating the release of glucose into the bloodstream to raise blood glucose levels between meals. Hepatocytes in the liver store glucose in large macromolecules known as glycogen. Glucagon binding to receptors on hepatocytes triggers the breakdown of glycogen into many glucose molecules, which are then released into the bloodstream. Prepared by Tim Taylor, Anatomy and Physiology Instructor Gastrectomy - No Stomach For Cancer Gastrectomy Email Hereditary Diffuse Gastric Cancer (HDGC) is one type of stomach cancer that is sometimes caused by a mutation in the CDH1 gene.

These stomach cancer cells are diffuse, meaning that they are widely spread or scattered throughout the stomach, making it nearly impossible to detect them at an early stage. The recommended treatment to prevent the development of this aggressive form of stomach cancer in CDH1 gene mutation carriers is prophylactic (preventive) total gastrectomy – complete removal of the stomach. People with other types of stomach cancer may also undergo total gastrectomy as part of their treatment plan. Total gastrectomy is also performed to treat some non-cancer medical conditions. The reconstruction that follows total gastrectomy is referred to as Roux-en-y. Preparing for Gastrectomy Choosing a Surgeon Living without a Stomach The Surgery The diagrams below show the anatomy before and after reconstruction. The part of the small bowel that is initially cut at the lower end of the duodenum is extended straight up to meet the esophagus. The cut end of the duodenum is then reconnected to the small bowel. The entire procedure generally takes 4-5 hours followed by a hospital stay of 7-10 days. Often food and drink are withheld for the first 3-5 days, and moistened swabs are used to relieve dryness of the lips and mouth.

The new construction needs time to heal and seal as leakage where the small bowel has been connected to the esophagus and small intestine can be lethal. An x-ray test is often used to check for leaks before drinking and eating may resume. The first 2-4 weeks following surgery can be challenging. It may be uncomfortable or painful to eat, but this is a normal part of the healing process. Some surgeons will insert a feeding tube to supplement nutrition for a period of time following surgery – something to talk about prior to surgery. Life After Surgery The goal after surgery is to work toward settling into a “new normal”, allowing the body to heal and adjust to the loss of the stomach over time. At the same time it is important to try to consume as many calories as possible to minimize rapid weight loss in the first few months following surgery, and to take in nutrients that the body needs to aid in the healing process. Starting to eat and drink again can be difficult, requiring a determined effort. It’s a lot of work, and sometimes feels as though life suddenly revolves around eating and drinking – what, when, where and how much. Familiar sensations of hunger may be lost, replaced by feelings of weakness and emptiness.

In the beginning eating and drinking is out of necessity, soon to become habit, and eventually the desire to eat and enjoyment of food returns. Most people will experience dumping syndrome at some point in time. Dumping syndrome is a group of symptoms that may occur 30-60 minutes after eating caused by rapid entry (or dumping) of food into the small intestine. Symptoms include nausea, vomiting, cramps, abdominal pain, diarrhea and feeling full after eating only a small amount of food. Symptoms may also occur 90 minutes to 3 hours after eating caused by a rapid rise in blood sugar and then a rapid decrease in blood sugar. These symptoms are sweating, fast heart rate, and weakness, feeling tired or mental confusion. Nausea, heartburn and gas are also common. Symptoms can be controlled through eating habits and dietary changes. To avoid symptoms it is helpful to eat 6-8 small meals daily to avoid eating too much at one time. Drinking 1 hour before or after a meal rather than with a meal is recommended. Eating small amounts of food, taking small bites and thoroughly chewing is important.

Food tolerance varies by individual; learning is through trial and error, and it is important to remember that food tolerances continue to change over time. Foods high in sugar often lead to dumping syndrome, especially in the first three to six months. Permanent weight loss of 20% of total body weight is typical within the first 3-6 months. Due to this rapid weight loss gallstones may develop, and can lead to removal of the gallbladder. Osteoporosis becomes a concern, one of the many reasons to pay attention to nutrition and supplements following surgery. Maintaining proper vitamin levels is important. Vitamin supplements are important when nutrients cannot be acquired through diet alone. Monthly B12 shots are critical; it is not possible to absorb B12 without a stomach. Consuming enough calories to maintain activity levels is possible over time – people have returned to competitive running, hiking, and all sorts of things. Nutritious, high calorie, low sugar foods provide the best bang for the bite. Just finding those can be a challenge! It may a year or two, but eventually the body seems to adjust quite well to the absence of the stomach.

Preventive Total Gastrectomy is curative for HDGC, the complete removal of the high risk and high anxiety of stomach cancer from your life. The best part about life after surgery . . . is life! For more detailed information about caring for yourself following surgery refer to the Postsurgical Care and Nutrition section of the latest HDGC clinical guidelines . Gastrectomy - Stomach Removal - Healthgrades.com - How is a gastrectomy performed? ADVERTISEMENT How is a gastrectomy performed? Your surgeon will perform your gastrectomy by making an incision in your abdomen to remove the damaged part of your stomach. The healthy part of the stomach is reattached to the small intestine. If your whole stomach needs to be removed (total gastrectomy), your surgeon will connect the small intestine directly to the esophagus. Surgical approaches to gastrectomy Your doctor will perform a gastrectomy using one of the following approaches: Minimally invasive surgery is a procedure performed by inserting special instruments and a laparoscope through small incisions in the abdomen. The laparoscope is a thin, lighted camera that transmits pictures of the inside of your body to a video screen.

Your doctor sees the inside of your abdomen on the computer screen as he or she performs the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your doctor will make small incisions instead of a larger one used in open surgery. He or she can thread surgical tools around structures, such as muscle, instead of cutting through or displacing them as in open surgery. Open surgery is performed by making a large incision in the abdomen. Open surgery allows your surgeon to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. This is because it causes more trauma to tissues. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients. In some cases, your surgeon may decide after beginning a minimally invasive procedure that you require an open surgery to safely and most effectively complete your surgery. Your surgeon will determine which type and method of surgery is best for you and how long you need to stay in the hospital based on certain factors.

These include your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different gastrectomy procedures and ask why your surgeon will use a particular type of surgery for you. Types of anesthesia that may be used Your doctor will perform a gastrectomy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. What to expect the day of your gastrectomy The day of your surgery, you can expect to: Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you understand and sign the surgical consent. Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. The surgical team will give you blankets for modesty and warmth. Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive. A surgical team member will start an IV.

The anesthesiologist or nurse anesthetist will start your anesthesia. Your anesthesiologist will place a tube in your windpipe to protect and control your breathing during general anesthesia. You will not feel or remember this or the surgery as they happen. Once you are asleep, a surgical team member will insert a tube through your nose and pass it through your throat into your stomach. This removes stomach contents in preparation for the gastrectomy. It stays in after the surgery for several days to rest your remaining stomach. The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable. Surgical Steps of Laparoscopic Sleeve Gastrectomy | Laparoscopic.MD Bariatrics Sleeve Surgical Steps of Laparoscopic Sleeve Gastrectomy What is done to my intestines during laparoscopic sleeve gastrectomy? Laparoscopic Sleeve Gastrectomy requires changing the stomach from the size of a football to the size and shape of a banana. A small gastric reservoir is created that reduces the stomach size to 60-150 ml. The operation involves the removal of the upper rounded part of your stomach called the fundus.

The fundus is one of the parts of the stomach that produces ghrelin, the hormone that controls your appetite. While not yet completely understood, the removal of the fundus during sleeve gastrectomy seems to be one of the reasons why a sleeve gastrectomy is not just a restrictive procedure. Sleeve Gastrectomy preserves many of your natural anatomic structures and connections including the antrum and pylorus along with vagus nerve innervation. Approximately 75%–80% of the greater curvature is excised, leaving a narrow stomach tube. Surgical Steps of Laparoscopic Sleeve Gastrectomy To gain access to the abdominal cavity, small incisions are created on the abdominal wall. Trocars, which serve as passageways for the surgical instruments, are placed through these skin incisions. Surgical instruments are passed through the trocars to access the abdominal cavity. The abdomen is filled with carbon dioxide (CO2) gas to lift the stomach wall away from the small intestine and other organs. The surgeon examines the abdominal cavity using the laparoscope which is a specialized video camera. One of the first steps of the operation is positioning the liver.

The edge of your liver sits directly over part of your esophagus and the first portion of the stomach. A retractor is placed which lifts the liver off of your stomach. This ensures that the whole stomach is adequately seen during the sleeve gastrectomy. The tissue that attaches the stomach to the omentum is then separated so that the area under the stomach can be visualized. This allows the surgeon to have a view of the space behind the stomach. There are many important organs that lie below this part of the stomach including the pancreas and spleen. The surgeon then continues to cut and seal these attachments and small blood vessels that lie on the larger side of the stomach, known as the greater curvature. This ligation of blood vessels and tissues continues along almost the entire length of this curve of your stomach extending from your esophagus to close to the area where the stomach attaches to the first part of your small intestines, the duodenum. This separation of tissue requires the recognition of many anatomic landmarks. The dissection is carried from the tissue at the junction of the lower esophageal sphincter, the gastroesophageal junction in an area known as the angle of His.

The angle of His is the acute angle created between the first part of the stomach at the entrance to the stomach and the esophagus. The angle of His has been implicated in reflux disease. This angle is opened up almost completely during sleeve gastrectomy and is therefore rendered irrelevant. Greater curvature ligaments, the fibrous tissue that connects stomach and spleen (gastrosplenic), and stomach and large intestine (gastrocolic), are divided. The stomach is fully separated from spleen and bowels. The entire underside of the stomach from the greater curvature must be completely free from all the attachments up to the left crus of the diaphragm i.e. structures that attach the diaphragm to the vertebral column. The blood supply on the left side of the stomach as well as the left branch of the vagus nerve remains preserved. Separating the stomach by Stapling near the Angle of His The photo demonstrates the position of the sleeve gastrectomy under the liver. The stapler is shown in one of the final stages of dividing the stomach in the area of the angle of His and the gastroesophageal junction. This portion of the operation requires a judgement with regards to amount of stomach resection and blood supply.

The surgeon then checks for the presence of hiatal hernia, the protrusion of the upper part of the stomach into the thorax through an opening in the diaphragm. If hiatal hernia is present, the defect is closed with sutures anterior to the esophagus and possibly posterior as well. After the pylorus, part of the stomach that connects to the duodenum, is identified and the greater curve of the stomach is elevated. The surgeon then enters the lesser sac, the general cavity of the abdomen by entering the division of the greater omentum. A sizing device called a bougie is then placed into the pyloric channel. The thick antrum or cavity of the stomach is divided by cutting transversely around the bougie to create a gastric tube. The pylorus, the valve that regulates emptying of the stomach, is spared along with a portion of the antrum ensuring preserved gastric emptying. The stomach is divided up to the level of the gastroesophageal junction, the lower part of the esophagus that connects to the stomach. Judging the size of a Sleeve Gastrectomy The stomach is demonstrated at an early stage of being divided.

Looking along the left side of the stomach, the lesser curvature, it is possible to visualize the bougie which is measuring the ideal size of the stomach pouch. The first staple line with buttress can be seen at the bottom of the picture. A gastric sleeve is a pouch with an estimated capacity of less than 150 ml. Stapling along the length of the stomach formed by the bougie creates a narrow tube. The staple line may be covered with material that is meant to reduce the risk of bleeding and/or leaks. Extra care is taken to avoid relative narrowing at the junction between the vertical and horizontal parts of the stomach in an area of a notch, the incisura angularis. Your stomach is completely divided during sleeve gastrectomy. The entire staple line is inspected for bleeding and visually inspected for dysfunctional staples or a leak. Sleeve Gastrectomy Demonstrating Divided Stomach Laparoscopic sleeve gastrectomy completely divides the stomach into two pieces. The objective of the operation is to decrease the remaining size of the stomach as well as to resect the fundus, the portion of the stomach that is likely involved in the hunger response. The picture above demonstrates the separated stomach to the right.

It appears a purple color because all of the blood supply has been cut in order to facilitate its removal. The resected stomach is placed in a specimen bag and then extracted through the trocar site. The remaining portion of your stomach would be the size and shape of a banana. The port sites are then closed with nonabsorbable sutures to prevent port site hernia. Laparoscopic Gastric Sleeve is becoming more popular whether as a primary, staged, or revisional operation. Laparoscopic sleeve gastrectomy is now an established stand-alone bariatric procedure worldwide. Sleeve Gastrectomy Shown Under Liver Edge One of the final stages of the operation involves removing the separated stomach portion. The cut edge of the gastric sleeve can be visualized just beneath the edge of the liver. The staple line appears irregular because it is lined with surgical staple buttress material. The plastic bag used for specimen removal as well as the resected stomach can be seen in the bottom left of the picture.

Medical Condition: GASTRIC SLEEVE SURGERY - ABOUT THE SLEEVE GASTRECTOMY Gastric Sleeve Surgery RESEARCH THE SLEEVE GASTRECTOMY PROCEDURE How Does The Sleeve Gastrectomy Work? The vertical sleeve gastrectomy is a restrictive form of weight loss surgery in which approximately 85% of the stomach is removed leaving a cylindrical or sleeve shaped stomach with a capacity ranging from about 60 to 150 cc, depending upon the surgeon performing the procedure. Unlike many other forms of bariatric surgery, the outlet valve and the nerves to the stomach remain intact and, while the stomach is drastically reduced in size, its function is preserved. Again, unlike other forms of surgery such as the Roux en Y gastric bypass, the sleeve gastrectomy is not reversible. Because the new stomach continues to function normally there are far fewer restrictions on the foods which patients can consume after surgery, albeit that the quantity of food eaten will be considerably reduced. This is seen by many patients as being one of the great advantages of the sleeve gastrectomy, as is the fact that the removal of the majority of the stomach also results in the virtual elimination of hormones produced within the stomach which stimulate hunger.

Perhaps the greatest advantage of the gastric sleeve lies in the fact that it does not involve any bypass of the intestinal tract and patients do not therefore suffer the complications of intestinal bypass such as intestinal obstruction, anemia, osteoporosis, vitamin deficiency and protein deficiency. It also makes it a suitable form of surgery for patients who are already suffering from anemia, Crohn's disease and a variety of other conditions that would place them at high risk for surgery involving intestinal bypass. Facts about the sleeve gastrectomy: Alternative names: vertical sleeve gastrectomy, sleeve gastrectomy, greater curvature gastrectomy, parietal gastrectomy, gastric reduction and vertical gastroplasty. Surgery for high BMI patients. For patients with a particularly high body mass index (typically 50+) many forms of weight loss surgery are either difficult to perform or present increased risk. As a result, a vertical sleeve gastrectomy (or increasingly a laparoscopic sleeve gastrectomy) is sometimes performed as the first of a two-part weight loss solution to provide an initial drop in weight which then makes other bariatric follow up possible at a reduced level of risk. Surgery for low BMI patients.

For obese patients with a relatively low body mass index the vertical sleeve gastrectomy can also prove a good choice, especially where existing conditions (such as anemia or Crohn's disease) prevent them from having other forms of bariatric surgery. In addition, patients may choose this form of surgery if they are concerned about the long-term effects of bypass surgery or object to having a 'foreign' body implanted into their body, as is the case with lap band surgery. During sleeve gastrectomy, the surgeon will remove the larger, rounded part of the stomach. The remaining stomach looks like a sleeve (or hose or tube) and holds about 15 percent as much food as the original stomach. The surgeon will remove the larger, rounded part of the stomach from the body. (This is the only gastric surgery in which part of the stomach is taken out of the body.) Unlike gastric bypass, which changes stomach openings, sleeve gastrectomy leaves the openings intact. It may be a safer and more effective option than gastric bypass for patients with very high BMI, those with medical problems like anemia, Crohnï¿½s disease, osteoporosis, extensive prior surgeries and other complex medical conditions.

Gastrectomy Overview, Surgical Procedure - Gastrointestinal Surgery - HealthCommunities.com Gastrointestinal Surgery Print Gastrectomy Overview Gastrectomy is the surgical removal of all or part of the stomach. This surgery is performed as a treatment for stomach cancer and may also be indicated for a bleeding gastric ulcer, a perforation (hole) in the stomach wall, and noncancerous polyps. The stomach plays such a large role in digestion, that it may be hard to believe that this organ can be removed. Yet, a person can adjust to living without a stomach. The stomach connects to the esophagus (tube that carries food from the mouth) on one end and the small intestine (primary site of nutrient absorption) on the other end. When part of the stomach is removed, the remaining portion continues its digestive function. If the entire stomach is removed, the esophagus is attached to the small intestine, the digestive process begins in the small intestine, and the body eventually adapts. Dietary changes may be necessary. Gastrectomy Surgical Procedure General anesthesia is used to render the patient unconscious, so they do not experience pain and have no awareness during the operation.

When the anesthesia has taken effect, a urinary catheter is usually inserted to monitor urine output. A nasogastric tube (i.e., a thin tube from the nose down into the stomach) is also put in. The abdomen is then cleansed with an antiseptic solution. The surgeon makes a large incision from just below the breastbone to the navel. If the lower end of the stomach is diseased, the surgeon places clamps on either end of the area and that portion of the stomach is removed. The upper part of the stomach is then attached to the small intestine. If the upper end of the stomach is diseased, the end of the esophagus and the upper part of the stomach are clamped. The affected portion is removed, and the lower part of the stomach is attached to the esophagus. In a total gastrectomy, clamps are placed on the end of the esophagus and the end of the small intestine. The stomach is removed and the esophagus is joined to the intestine. Lymph nodes, a section of the pancreas, and the spleen are often removed in cases of cancer. The abdomen is sutured.

The nasogastric tube remains in place and is removed during the postoperative period. Surgery generally takes between 1 and 3 hours, depending on the diagnosis and the extent of the disease. Publication Review By: Stanley J. Swierzewski, III, M.D. Published: 31 Oct 2001 Surgery to remove your stomach | Cancer Research UK Surgery to remove your stomach Surgery to remove your stomach Find out about the different types of surgery for stomach cancer. The type of surgery you need for cancer of the stomach depends on which part of the stomach the cancer is in. What type of surgery do I need? Operations to remove stomach cancer are major surgery. You have them under general anaesthetic. You’ll be asleep for the whole operation. You’ll need to travel to a specialist centre to have your surgery. You may have part or all of your stomach removed. You won’t need a stoma (bag) For very early small cancers (stage 1A) your doctor may be able to remove the lining of your stomach. Your surgeon removes this using a long flexible tube (endoscope). The procedure is called an endoscopic mucosal resection (EMR).

Find out more about removing the lining of the stomach Removing part of the stomach Your surgeon may remove up to two thirds of your stomach if the cancer is at the lower end of your stomach. This is a subtotal gastrectomy. How much the surgeon removes depends on the position of the cancer. The surgeon will also remove part of the sheet of tissue that holds the stomach in place (omentum). You’ll have a smaller stomach afterwards. The valve (cardiac sphincter) between your food pipe (oesophagus) and stomach will still be there. Removing the stomach This operation is for when the cancer is in the middle of the stomach. The surgeon removes the whole stomach and all of the omentum. This is a total gastrectomy with a Roux-en-Y reconstruction. Your surgeon rejoins your food pipe (oesophagus) to your duodenum. Removing the stomach and part of the food pipe This operation is for cancer that is in the area where the stomach joins the food pipe (oesophagus). The surgeon removes your stomach and part of your food pipe. This is an oesophagogastrectomy. Your surgeon keeps the lowest third of your stomach and makes it into a tube.

They rejoin this tube with the remaining part of your food pipe. Removing lymph nodes During your operation the surgeon examines the stomach and surrounding area. They take out all of the lymph nodes from around your stomach and along the main blood vessels to the stomach. The surgeon takes out lymph nodes in case they contain cancer cells that have spread from the main cancer. Taking the nodes out reduces the risk of your cancer coming back in the future. It also helps your doctor to decide if you need chemotherapy after your surgery. The number of lymph nodes your surgeon removes varies. For people who are less fit the surgeon may only remove the lymph nodes closest to the stomach. How your surgeon does your operation To remove cancer of the stomach you may have open surgery or keyhole surgery. Most people have open surgery. Open surgery The type of surgery you have depends on where the cancer is in your stomach. It also depends to some extent on which your surgeon prefers.

The types are: subtotal gastrectomy, which means having the operation through a cut in your tummy (abdomen) total gastrectomy, which is when the surgeon makes one cut to your tummy to remove whole of the stomach thoraco-abdominal oesophago-gastrectomy, which means the surgeon has to remove the stomach and food pipe though a cut in your tummy and chest Depending on which operation you have, you may have: one vertical scar on your tummy (vertical) one scar like an upside down V on your tummy (rooftop) one scar across your chest either on the left or the right and one down the middle of your tummy (chest scar) Keyhole surgery Keyhole surgery is also called minimal access surgery or laparoscopic surgery. It means having an operation without needing a major cut in your tummy (abdomen). It is possible for a surgeon to remove the whole of your stomach, or part of it, using keyhole surgery. You have this type of surgery in specialist centres by a specially trained surgeon. The surgeon makes 4 to 6 small cuts in your tummy. They use a long tube called a laparoscope.

Having keyhole surgery The laparoscope connects to a fibre optic camera. This shows pictures of the inside of the body on a video screen. The surgeon then uses the other incisions to put the other instruments they use to do the surgery into your body. Using the laparoscope and other instruments, the surgeon frees the stomach so they can remove either all or part of it. They then either join the remaining stomach to the bowel or your oesophagus to your bowel if they removed your whole stomach. Laparoscopic surgery takes 30 to 60 minutes longer than the more common ways of removing the stomach (open surgery). UK guidelines for keyhole surgery The National Institute for Health and Care Excellence (NICE) has guidelines for keyhole surgery. These state that surgeons can use it to remove cancer of the stomach but they must: tell people having the surgery about the risks and benefits monitor people closely collect information about any problems people have and report on them Researchers are looking into whether keyhole surgery is as good as open surgery.

Last reviewed: Guidelines for the management of oesophageal and gastric cancer WH Allum and others Guidelines for diagnosis, treatment and follow-up Gastric cancer: ESMO–ESSO–ESTRO Clinical Practice T. Waddell and others, Annals of Oncology 24 (Supplement 6): vi57–vi63, 2013 Laparo-endogastric surgery National Institute for Health and Care Excellence (NICE) interventional procedure guidance [IPG25]. January 2012 Gastric cancer

Question: A gastrectomy is the removal of which part of the human body?
Answer: Stomach