What Is Gastrectomy? Types and How It Is Performed

What Is Gastrectomy?

Gastrectomy is surgery removing part or all of the stomach.

Its two main current uses are surgery for stomach cancer and obesity as indications. It may also be recommended for treatment. It can additionally be chosen for type-2 diabetes and gastroparesis (impaired stomach emptying).

Nutrition after gastrectomy differs from before. Although digestion changes somewhat, normal eating and drinking can continue. Portions begin very small and gradually increase under control. Recovery and adapting to a new diet take time.

This article covers types, recovery and complication risks.

What Types of Gastrectomy Exist?

The operation removes all or part of the stomach.

There are three main types:

• Removal of the entire stomach: total gastrectomy
• Removal of part: partial gastrectomy
• Removal of a portion from the left side to reduce stomach size: sleeve gastrectomy

Why Is Gastrectomy Used?

It may be recommended for:

Gastrectomy for Stomach Cancer

It is the main early-stage treatment. Depending on cancer type and stage, surgeons try to remove as little stomach as possible. For locally advanced disease (large tumor and/or surrounding lymph node involvement), an extensive operation called D2 dissection is performed).

The extent of surgery depends on stomach cancer stageas a factor. For best outcomes, before gastrectomy, neoadjuvant (tumor-shrinking), and afterward, adjuvant (protective) cancer treatments such as chemotherapy, radiotherapy or targeted drugs may be used.

Gastrectomy for Gastroparesis

Gastroparesis is very slow stomach emptying. Partial or total gastrectomy may be considered rarely and only in carefully selected patients. More research is needed before it becomes a common treatment.

Bariatric Surgery for Obesity

Operations treating obesity are generally called bariatric surgery as a group.

Gastrectomy may treat obesity only when other methods, such as diet, exercise and established medicines, have failed.

Gastrectomy for Diabetes

Since 2010, many studies show gastrectomy can improve outcomes in type 2 diabetes.

A study in 2015 reported gastric bypass and sleeve gastrectomy effective for diabetes and obesity treatment.

How Is Gastrectomy Performed?

Surgeons can use two approaches:

Open surgery is commonly preferred, removing the stomach through the abdomen.

Laparoscopic (keyhole) surgery uses several small incisions, generally healing faster and posing less risk than open surgery. Sleeve gastrectomy, particularly common for obesity, is increasingly laparoscopic.

After removing part of the stomach, the surgeon reconstructs the digestive system. A common method reconnecting digestive sections is Roux-en-Y gastric bypass surgery.

The figure below shows common bariatric surgery types

How Do You Prepare?

Routine blood tests are requested beforehand.

Dietary restrictions or avoiding certain foods may be required.

Routine tests generally include:

• Blood tests
• Urine tests
• ECG (electrocardiogram)
• Chest X-ray. Additional tests sometimes include:
• Upper endoscopy (esophagogastroduodenoscopy) 
• Endoscopic ultrasound 
• Computed tomography (CT)

What Happens After Gastrectomy?

Unless doctors or nurses advise otherwise, eat and drink things causing no discomfort. Bariatric surgery for obesity requires a strict, structured diet for up to 6 months, usually with specialist dietitian support. Sensitivities vary; remove difficult-to-digest foods and reintroduce them after a few weeks.

Helping Recovery

• Exercise. Keep moving even in bed to prevent thrombosis (blood clots) and muscle weakness. Simple stretches and movements support circulation and muscle strength.
  Deep breathing. Prolonged bed rest can cause infections such as pneumonia; deep-breathing techniques may prevent these complications.
• Pain control. Tell the doctor or nurse about pain. Effective management helps return to normal sooner.
• Avoid certain activities. Limit swimming and heavy lifting until medically cleared.
• Stitches are generally removed 7-10 days after surgery, after which normal activities can gradually resume.

Life After Gastrectomy

Some foods may be harder to digest afterward.

Diet generally must change because the stomach is smaller, the intended obesity-treatment effect. After cancer surgery, returning to previous habits may be faster. Discuss suitable foods with a doctor or dietitian.

Regularly monitor these blood values afterward: 

• Vitamin B-12
• Iron
• Folate
• Calcium
• Vitamin D

Complications and Adverse Effects

After partial or total gastrectomy, up to 75 percent may experience, due to rapid intestinal food passage, diarrhea as a symptom.

Other complications include: 

• Acid reflux or heartburn
• Nausea
• Difficulty eating 
• Constipation 
• Diarrhea 
• Indigestion
• Roux syndrome
• Abdominal pain

Adequate nutrition may be difficult, causing anemia, impaired bone metabolism from calcium and vitamin D deficiencies, and potentially weight loss from poor micronutrient absorption.

Contact a doctor for any of these postoperative symptoms:

• Warmth or redness around the surgical area
• Inflammation in the area
• Fever above 38 degrees
• Inability to drink fluids
• Pain unrelieved by medication

In conclusion,total or partial gastrectomy effectively treats stomach cancer and can treat obesity. Knowing what to expect before, during and after helps the surgical experience.