Gastrectomy

Preoperative Preparation, Surgical Procedure, and Postoperative Care for Gastrectomy (Stomach Removal Surgery)  

 

Gastrectomy—the surgical removal of part or all of the stomach—is a major operation typically performed for conditions such as    gastric cancer   ,    refractory peptic ulcers   , or, in some cases, as part of    bariatric surgery    (e.g., sleeve gastrectomy for weight loss). The procedure may be    partial    (removal of a portion of the stomach) or    total    (complete removal of the stomach).

 

Below is a comprehensive overview of preoperative preparation, surgical steps, and postoperative care:

 

📌    Preoperative Preparation  

 

1. Comprehensive Medical Evaluation

– Complete physical examination 

– Blood tests (CBC, electrolytes, liver and kidney function, coagulation profile) 

– Imaging studies: Upper endoscopy, abdominal ultrasound, CT scan, or PET-CT (especially for cancer staging) 

– ECG and cardiac assessment (particularly in elderly patients or those with cardiovascular history)

 

2. Medication Management

–    Anticoagulants    (e.g., warfarin, aspirin, clopidogrel): Usually discontinued several days before surgery under physician supervision. 

–    Diabetes medications   : Require careful adjustment; insulin may be administered intravenously on the day of surgery. 

–    NSAIDs    (nonsteroidal anti-inflammatory drugs): Typically stopped due to bleeding risk.

 

3. Dietary and Bowel Preparation

–    Strict fasting   : Nothing by mouth for 8–12 hours before surgery. 

– In some cases (e.g., cancer surgery),    bowel cleansing solutions    or    prophylactic antibiotics    may be prescribed.

 

4. Patient Education and Psychological Preparation

– Explanation of the type of surgery (partial vs. total), expected digestive changes, lifelong need for vitamin supplementation (especially B12, iron, calcium), and dietary modifications 

– Discussion of potential complications and extended recovery period

 

🔪    Surgical Procedure  

 

1. Anesthesia

– The patient is placed under    general anesthesia   .

 

2. Surgical Approach

–    Open laparotomy    (large abdominal incision) or    laparoscopic surgery    (minimally invasive, using several small incisions), depending on the patient’s condition and disease severity.

 

3. Stomach Resection

– In    total gastrectomy   : The entire stomach is removed, and the esophagus is directly connected to the small intestine (typically the jejunum)—called an    esophagojejunostomy   . 

– In    partial gastrectomy   : Only a portion (usually the lower part) of the stomach is removed, and the remaining stomach is reconnected to the duodenum or jejunum.

 

4. Lymph Node Dissection

– In cancer cases, regional    lymph nodes    are also removed (lymphadenectomy) for staging and therapeutic purposes.

 

5. Drain Placement and Closure

– One or more    surgical drains    are inserted to remove fluid from the surgical site. 

– The abdominal incision is closed with sutures or staples.

 

6. Duration

– The surgery typically lasts    2 to 4 hours   , depending on complexity and approach.

 

 🩹    Postoperative Care  

 

1. Hospital Stay

– Patients usually remain hospitalized for    5 to 10 days   . 

– Shorter stays may be possible after laparoscopic procedures.

 

2. Monitoring for Complications

–    Pain   : Managed with analgesics. 

–    Digestive disturbances   : Nausea, vomiting, or    dumping syndrome    (rapid gastric emptying)—common after total gastrectomy. 

–    Anastomotic leak   : Signs include fever, severe abdominal pain, and tachycardia—this is a surgical emergency. 

–    Intra-abdominal infection or abscess     

–    Nutritional deficiencies   : Especially    vitamin B12    (requires lifelong injections), iron, calcium, and vitamin D

 

3. Nutrition After Surgery

–    Initial days   : Intravenous (IV) fluids or enteral feeding via a jejunal tube 

–    First week   : Gradual progression from clear liquids to soft, small-volume meals 

–    Long-term diet   : Frequent small meals (5–6 times/day), avoidance of simple sugars, and separation of fluids from solid food

 

4. Medications

–    Antibiotics   : If indicated 

–    Proton pump inhibitors (PPIs)   : To manage acid if part of the stomach remains 

–    Vitamin supplements   : Lifelong B12 (injectable), iron, calcium, and vitamin D—especially after total gastrectomy

 

5. Physical Activity

– Early ambulation (starting the first postoperative day) to prevent blood clots 

– Avoidance of heavy lifting or strenuous activity for    6–8 weeks  

 

6. Follow-up

– Regular visits with the surgeon and gastroenterologist 

– Periodic blood tests (hemoglobin, ferritin, B12, electrolytes) 

– In cancer cases: Ongoing surveillance with CT scans, endoscopy, and tumor markers

 

Warning Signs Requiring Immediate Medical Attention

– High fever or chills 

– Severe or worsening abdominal pain or distension 

– Persistent vomiting or inability to tolerate oral intake 

– Drainage of blood or pus from the incision or drain site 

– Signs of dehydration (dizziness, decreased urination, dry mouth)