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Gastrectomy – Stomach Removal: Procedure, Risks & Recovery
A gastrectomy is a surgical procedure to remove all or part of the stomach. It is most commonly performed for stomach cancer and requires long-term dietary adjustments.
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A gastrectomy is a surgical procedure to remove all or part of the stomach. It is most commonly performed for stomach cancer and requires long-term dietary adjustments.
What is a Gastrectomy?
A gastrectomy is a surgical procedure in which all or part of the stomach is removed. A total gastrectomy involves the complete removal of the stomach, while a partial gastrectomy removes only a portion of it. After a total gastrectomy, the esophagus is connected directly to the small intestine to allow food to continue passing through the digestive tract.
Indications
A gastrectomy may be recommended in the following situations:
- Stomach cancer (gastric carcinoma): The most common indication, often combined with removal of nearby lymph nodes (lymphadenectomy)
- Severe gastrointestinal bleeding that cannot be controlled by other means
- Gastric perforation (a hole or rupture in the stomach wall)
- Benign tumors that are large or in a critical location
- Bariatric surgery: Sleeve gastrectomy for the treatment of severe obesity
Types of Gastrectomy
Total Gastrectomy
In a total gastrectomy, the entire stomach is removed and the esophagus is connected directly to the small intestine (esophagojejunostomy). This procedure is typically performed for advanced gastric cancer.
Partial (Distal or Proximal) Gastrectomy
Only a portion of the stomach is removed — either the lower section (distal) or the upper section (proximal). The remaining stomach is then reconnected to the small intestine.
Sleeve Gastrectomy
In a sleeve gastrectomy, the majority of the stomach is removed along the greater curvature, leaving a narrow, tube-shaped stomach with significantly reduced capacity. This procedure is commonly used in bariatric surgery for patients with severe obesity.
Surgical Procedure
A gastrectomy is performed under general anesthesia. The surgery can be carried out as an open procedure (through a large abdominal incision) or minimally invasively using laparoscopic techniques (small incisions with a camera). The laparoscopic approach is less invasive and typically allows for faster recovery.
Risks and Complications
As with any major surgery, a gastrectomy carries potential risks:
- Postoperative bleeding and infection
- Anastomotic leak (leakage at the surgical connection point)
- Dumping syndrome: Symptoms caused by food passing too quickly into the small intestine, including nausea, sweating, and dizziness after eating
- Nutritional deficiencies, particularly vitamin B12, iron, calcium, and fat-soluble vitamins
- Unintended weight loss and malnutrition
- Bile reflux into the esophagus
Life After Gastrectomy
Long-term dietary changes are essential after a gastrectomy. Patients are generally advised to:
- Eat several small meals throughout the day (5–6 meals)
- Separate solid foods and liquids (avoid drinking during meals)
- Choose easily digestible, nutrient-dense foods
- Have regular blood tests to monitor nutritional levels
- Take lifelong vitamin B12 supplements (usually by injection, as absorption through the stomach is no longer possible) and other nutrients as needed
Close collaboration with a dietitian and the treating physician is essential following the procedure.
Follow-Up Care and Rehabilitation
After a gastrectomy for stomach cancer, regular follow-up examinations (endoscopy, imaging, laboratory tests) are necessary to detect any recurrence of the disease at an early stage. Psychological support and nutritional therapy are also important components of rehabilitation.
References
- S3-Leitlinie Magenkarzinom, Deutsche Gesellschaft fuer Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), 2019/2022.
- Lordick F. et al. – Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2022.
- Schwartz's Principles of Surgery, 11th Edition, McGraw-Hill Education, 2019.
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