Gastrectomy is a surgical procedure to completely remove the stomach. If only part of the stomach is removed, it is referred to as gastric resection or partial gastric resection.
Indications (areas of application)
Gastric resection (partial stomach removal) or gastrectomy (stomach removal) is performed for:
- Gastric carcinoma* (stomach cancer) – in this case, a total gastrectomy with lymphadenectomy (removal of lymph nodes) is performed; only in the case of early diagnosis of gastric carcinoma, a partial resection may possibly be performed
- Gastric ulcers (gastric ulcers) – in this case, a partial gastric resection is usually performed; the method is performed only in cases of therapy-resistant ulcers
* The goal of surgical therapy is complete tumor removal as R0 resection (removal of the tumor in healthy tissue; in histopathology, no tumor tissue is detectable in the resection margin). The necessary safety distance is 5 cm in intestinal carcinoma and 8cm in diffuse type in situ.Quite crucial in curative therapy of early gastric carcinoma is attention to possible lymph node metastasis.
Surgical procedures
After removal of the stomach or a portion of the stomach, the esophagus (food pipe) is sutured to the remaining portion of the stomach or duodenum (duodenum) to allow continued passage of food.
One can distinguish several surgical procedures – depending on the indications:
- Antrum resection – removal of the last section of the stomach before the transition to the duodenum (duodenum).
- Billroth I resection – partial removal of the stomach; subsequent anastomosis (connection) between the gastric remnant and the duodenum (duodenum).
- Billroth II resection – partial removal of the stomach; subsequent anastomosis (connection) between the gastric remnant and the jejunum (empty intestine); the upstream portion of the intestine ends blindly and is connected to the draining jejunum portion
- Roux-Y resection – reconstruction procedure after gastrectomy; anastomosis (connection) between the gastric remnant and the jejunum (empty intestine); the duodenum (duodenum; physiologically upstream) is also connected to the jejunum (so-called end-to-side anastomosis)
- Total gastrectomy – total stomach removal.
Possible complications
- Bleeding
- Infections
- Wound healing disorders
- Incisional hernia – abdominal wall hernia in the area of the surgical scar.
- Suture insufficiency – inability of the suture to adapt the tissues.
- Dumping syndrome (postgastrectomy syndrome).
- Anastomotic stenosis – narrowing of the connecting suture.
- Anastomosis ulcer – formation of ulcers in the area of the connecting suture.
- Thromboembolism – occlusion of a pulmonary artery by a blood clot.
- Pneumonia (inflammation of the lungs)
- Malnutrition (malnutrition)
- Alkaline reflux esophagitis – esophagitis without the stomach acid or pepsin plays a role.
- Iron deficiency anemia – anemia due to iron deficiency.
Perioperative mortality (death rate during surgery) for standard resections is well below 5% in experienced centers.
