What you need to know about:

Gastrectomy

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Overview of

Gastrectomy

in Thailand

A gastrectomy is a general term used to describe a surgical procedure used to remove any part of or all of the stomach. There are several types of gastrectomies, each with a different purpose: -Total gastrectomy -Partial gastrectomy, distal gastrectomy, wedge resection etc. -Proximal gastrectomy -Sleeve gastrectomy -Gastric bypass

Goals of

Gastrectomy

Gastrectomies are a treatment option for stomach-related disease that cannot be treated any other way. Conditions that may warrant this procedure may commonly include:  

1.Non-cancerous mass in the stomach

2.Bleeding in the stomach

3.Severe gastroenteritis

4.Perforation of the stomach wall

5.Polyps in the stomach

6.Stomach cancer

7.Ulcer in the stomach

8.Life-threatening or morbid obesity

Price of

Gastrectomy

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Pros and cons of

Gastrectomy

Pros

Gastrectomies are definitive treatment to other treatment approaches that fail to work based on the patient's current condition.

Cons

Gastrectomies are considered major surgeries and therefore come with several risks.

How it works:

Gastrectomy

Different gastrectomies procedures vary with different treatments. Here are some of the few commonly performed procedures:  1. Cancer: 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.  

2. Gastroenteritis  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.  

3. Morbid obesity treatment [also known as bariatric surgery]  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.

Preparation before

Gastrectomy

Pre - treatment

You will undergo a physical examination, blood tests, abdominal x-ray, among many other tests. The doctor will review your medical history to ensure you are ready for the surgery. You will be asked to stop smoking before and after the surgery as smoking delays healing and can cause complications. 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.

Recovery after

Gastrectomy

Post - treatment

A 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. 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 by themselves, 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 recovering at home, you should only perform light activities for the first 4-6 weeks. 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.

Risks & side effects

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.

FAQs:

Gastrectomy

Does weight loss surgery guarantee permanent weight loss?

No. A small percentage of patients will regain a substantial portion of the weight that is lost. This is occurs primarily when the patient does not follow the dietary guidelines in the months and years following the procedure.

What are the different types of weight loss surgery?

Gastric Bypass Surgery - this involves separating the stomach into two unequal compartments with less than 5% of the stomach remaining usable for food consumption. During digestion, the food empties from this tiny stomach pouch into the upper intestine.   Laparoscopic Banding - This involves an encircling of the stomach with an inflatable plastic band (such as the LAP-BAND® or REALIZE® Band), restricting food intake.   Sleeve Gastrectomy - Also known as Gastric Sleeve, this procedure involves the removal of approximately 85% of the stomach, leaving 15% of the original capacity which is shaped like a sleeve.  Biliopancreatic Diversion - This procedure involves the creation of a smaller stomach (similar to gastric bypass surgery), but in addition there is less absorption of ingested food inside the intestine.

How does the doctor decide which bariatric surgical procedure to proceed with?

Some surgeons only perform weight loss surgery using one approach (i.e., open or laparoscopically). Surgeons who perform both types of procedures usually prefer laparoscopic surgery, except in the heaviest of patients or those who require revisional surgery (second or third time operations).

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