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Gastrectomy

Gastrectomy is a surgical procedure to remove part of or all of the stomach.

Types of Gastrectomy
There are several types of gastrectomy, including:
  • Total gastrectomy
  • Partial gastrectomy, distal gastrectomy, wedge resection etc.
  • Proximal gastrectomy
  • Sleeve gastrectomy
  • Gastric bypass
Gastrectomy is a treatment option for stomach-related disease that cannot be treated any other way, such as:
  • Non-cancerous mass in the stomach
  • Bleeding in the stomach
  • Severe gastroenteritis
  • Perforation of the stomach wall
  • Polyps in the stomach
  • Stomach cancer
  • Ulcer in the stomach
  • Life-threatening obesity
  1. You will undergo a physical examination, blood tests, abdominal x-ray, etc. The doctor will review your medical history to ensure you are ready for the surgery.
  2. Stop smoking before and after the surgery as smoking delays healing and can cause complications.
  3. Please inform your medical team if you are pregnant or suspect that you may be pregnant. Please also let your doctor know of all medication, including dietary and herbal supplements that you are taking as some will need to be stopped before the procedure.
Cancer Treatment
Surgery is the treatment option for many kinds of stomach cancer and a part or the whole of the stomach will need to be removed, depending on the location and site of the cancer. It is also necessary to remove lymph nodes around the stomach at the same time. Research shows that the more lymph nodes are removed, the higher the survival rate.

Partial or total gastrectomy is often used to treat gastric adenocarcinoma, gastric lymphoma, and leiomyosarcoma, which is a rare cancer. The most common stomach cancer is adenocarcinoma, but it is harder to treat than gastric lymphoma, which is less common. Patients with gastric lymphoma have higher survival rates when treated with gastrectomy.

Gastrectomy for cancer can be done as open surgery or as minimally invasive surgery. The advantage of an open method is that it can be used to treat all stages of stomach cancer, from early stage to a more advanced state. The disadvantage is that the incision is much bigger and there is usually more pain associated with this procedure. Recovery is also slower and the patient will need to stay in hospital longer than with a minimally invasive procedure. There is also a higher risk of excessive bleeding as well as more bruising to tissue.
When it comes to minimally invasive surgery, there are two types: laparoscopic and robot-assisted. Both methods have the same principles and both involve 5-6 small incisions, measure just 0.5-2 centimeters, in the abdomen. One incision is often enlarged to remove part of or all of the stomach. The advantage of this procedure is that the incisions are small, so pain is minimal and recovery is quicker. Patients can often return home more quickly than those who undergo open surgery. Bleeding is also usually less and there is less impact to tissue. The limitations of minimally invasive surgery are that it can only be done for early stage to locally advanced stage cancer; it is too complicated for advanced disease, but an experience surgeon may still be able to use this method. Robot-assisted surgery is a new technology that allows for high accuracy. The surgeon controls the robot arm through a computer and guides it using a high-definition camera that provides three-dimensional images. In some cases, minimally invasive surgery may be switched to an open surgery.
Gastrectomy is done using general anesthesia so you will be asleep during the procedure and will not feel any pain. After the anesthesia is in effect, a catheter will be inserted to allow the team to monitor your urine output. A small tube will be inserted through your nose and down to your stomach. Then, depending on the size and location of the cancer and the type of surgery, the surgeon will begin the procedure. Some or all of the stomach will be removed, along with surround lymph nodes. The remaining stomach will be attached to the small intestine. If the cancer is in the top part of the stomach, that will be removed and the bottom part of the stomach will be attached to the esophagus. If the entire stomach is removed, the intestine is then attached to the esophagus.
 
Gastroenteritis Treatment
Sometimes gastrectomy may be a treatment option for severe ulcers/gastroenteritis or complications of disease. Normally ulcers in the stomach and intestines are treated with medication, but in patients with other complications, surgery may be appropriate. Candidates for surgery include those who don’t respond well to medication, those with bleeding in the stomach or perforation of the stomach, and those with obstruction in the stomach.

Surgery for ulcers that don’t respond to antacids involve an antrectomy and vagotomy to reduce the production of acid in the stomach, which causes ulcers. For bleeding in the stomach that doesn’t respond to medication, treatment involves endoscopy to close up any wounds to stop the bleeding and vagotomy to stop the production of acid. In the case of a perforation, treatment is the same—stitches to close the wound and vagotomy to sever the vagus nerve. All of these can be done with open surgery or minimally invasive surgery, with risks and benefits as mentioned above.
 
Non-Cancerous Growth Treatment
In the case of gastrointestinal stromal tumor (GIST), leiomyoma, large polyps, etc., wedge resection may be an appropriate treatment option where most of the stomach can be left intact. Lymph nodes do not need to be removed in this case as this type of growth does not spread to other parts of the body. A minimally invasive technique is recommended for non-cancerous growths, whether it be laparoscopic or robot-assisted.
 
Morbid Obesity Treatment
In the case of an obese patient who is unable to control their body weight with non-surgical options, such as diet control, medication, and exercise, and whose body mass index (BMI) is more than 37.5 or 32.5 with other medical conditions, such as diabetes, hypertension, and heart disease, they may be suitable for gastrectomy for weight loss. The most popular surgery is sleeve gastrectomy and gastric bypass. Both are performed with a minimally invasive technique, whether laparoscopic or robot-assisted.
 
Gastrectomy is a major surgery that requires a lengthy recovery. Most patients will stay in the hospital for 1 week after the procedure. During that time patients will receive intravenous nutrition until they are able to eat and drink normally. A drain is placed through the nose and into the stomach to drain liquid while the new “stomach” recovers and can function normally. The drain is then removed. Pain is normal after the procedure and can be managed with prescribed pain medication.

Ultimately, patients will be able to digest food and liquids normally, but may need to make some lifestyle adjustments, such as by eating smaller meals more frequently. Supplements may be necessary to ensure adequate intake of required nutrition. How a patient recovers will depend on their health and the reason for surgery.

When you are home, you should only perform light activities for the first 4-6 weeks. Please don’t drive while you are taking pain medication. At home, you may need to change your eating habits by eating smaller meals more frequently, avoiding high-fiber foods, and eating enough calcium, iron, Vitamin C, and Vitamin D.
There are risks associated with all types of surgery, including reaction to anesthesia, bleeding and infection. Risks and complications associated to gastrectomy include:
  • Acid reflux.
  • Diarrhea.
  • Inflammation of the incision.
  • Infection in the chest.
  • Internal bleeding.
  • Leaking from the stomach at the surgical site.
  • Nausea and vomiting.
  • Stomach acid leaking into the esophagus, causing scarring, narrowing or stricture.
  • Intestinal obstruction.
  • Vitamin deficiency.
  • Weight loss.
Complications are usually mild and can be resolved without medication or surgery.
 
  • If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.
  • Travelers to Thailand should plan to stay in the country for at least 2-3 weeks or for the entire duration of treatment.
  • If you plan to return home after the procedure, please speak to your doctor before making travel arrangements.
  • During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).
The success of the procedure depends on the patient’s health and lifestyle modifications. Please discuss your questions and concerns with your doctor.
 
What if the procedure is not performed?
The condition may worsen and affect daily life. For some stomach conditions, gastrectomy is the only treatment option.
 
Treatment options vary with the condition that needs to be treated. Please discuss all available and appropriate treatment options with your doctor.
 

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