Gastrectomy

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Gastrectomy
Diagram of the stomach, showing the different regions.
ICD-9-CM	43.5-43.9
MeSH	D005743
MedlinePlus	002945
[edit on Wikidata]

A gastrectomy is a partial or total surgical removal of the stomach.

Indications

Gastrectomies are performed to treat stomach cancer and perforations of the stomach wall.

In severe

Polya's operation

Also known as the Reichel–Polya operation, this is a type of posterior gastroenterostomy which is a modification of the Billroth II operation^[1] developed by Eugen Pólya and Friedrich Paul Reichel. It involves a resection of 2/3 of the stomach with blind closure of the duodenal stump and a retrocolic gastro-jejunal anastomosis.

Post-operative effects

The most obvious effect of the removal of the stomach is the loss of a storage place for food while it is being digested. Since only a small amount of food can be allowed into the small intestine at a time, the patient will have to eat small amounts of food regularly in order to prevent

Another major effect is the loss of the

Another side effect is the loss of ghrelin production, which has been shown to be compensated after a while.^[3] Lastly, this procedure is post-operatively associated with decreased bone density and higher incidence of bone fractures. This may be due to the importance of gastric acid in calcium absorption.^[4]

Post-operatively, up to 70% of patients undergoing total gastrectomy develop complications such as dumping syndrome and reflux esophagitis.^[5] A meta-analysis of 25 studies found that construction of a "pouch", which serves as a "stomach substitute", reduced the incidence of dumping syndrome and reflux esophagitis by 73% and 63% respectively, and led to improvements in quality-of-life, nutritional outcomes, and body mass index.^[5]

After Bilroth II surgery, a small amount of residual gastric tissue may remain in the duodenum. The alkaline environment causes the retained gastric tissue to produce acid, which may result in ulcers in a rare complication known as retained antrum syndrome.

All patients lose weight after gastrectomy, although the extent of weight loss is dependent on the extent of surgery (total gastrectomy vs partial gastrectomy) and the pre-operative BMI. Maximum weight loss occurs by 12 months and many patients regain weight afterwards.^[6]

History

The first successful gastrectomy was performed by Theodor Billroth in 1881 for cancer of the stomach.

Historically, gastrectomies were used to treat

• Finsterer-Hofmeister operation
• List of surgeries by type
• Roux-en-Y
• Sleeve gastrectomy

References

External links

Wikimedia Commons has media related to Gastrectomy.

• Sample meal plan for total gastrectomy