Gastric Resection – Procedure, Types & Aftercare
Gastric resection is a surgical procedure in which part or all of the stomach is removed. It is primarily used to treat stomach cancer, severe ulcers, or other serious gastric conditions.
Things worth knowing about "Gastric Resection"
Gastric resection is a surgical procedure in which part or all of the stomach is removed. It is primarily used to treat stomach cancer, severe ulcers, or other serious gastric conditions.
What is Gastric Resection?
Gastric resection refers to the surgical removal of part or all of the stomach. Depending on the extent of the surgery, it is classified as a partial gastrectomy (removal of a portion of the stomach) or a total gastrectomy (complete removal of the stomach). It is one of the major abdominal surgeries and is performed in specialized surgical centers.
Indications
Gastric resection is recommended when conservative treatments are insufficient to manage the following conditions:
- Gastric cancer (stomach cancer): the most common indication
- Peptic ulcer disease with complications such as bleeding or perforation
- Benign gastric tumors (e.g., GIST – gastrointestinal stromal tumors)
- Bariatric surgery (e.g., sleeve gastrectomy for obesity treatment)
- Severe stomach injuries
Surgical Procedures
Partial Gastrectomy
In a partial gastrectomy, only a portion of the stomach is removed. The main types include:
- Antrectomy: removal of the lower portion of the stomach (antrum)
- Subtotal gastrectomy: removal of approximately 75–80% of the stomach
- Sleeve gastrectomy: removal of the greater curvature of the stomach, primarily used in bariatric surgery
Total Gastrectomy
In a total gastrectomy, the entire stomach is removed. The esophagus is then directly connected to the small intestine (esophagojejunostomy). This procedure is primarily necessary in advanced stomach cancer cases.
Reconstruction Methods
After stomach removal, the continuity of the digestive tract must be restored. Common reconstruction techniques include:
- Billroth I: connecting the remaining stomach to the duodenum
- Billroth II: connecting the remaining stomach to a loop of the small intestine
- Roux-en-Y reconstruction: Y-shaped connection of the small intestine, commonly used after total gastrectomy
Procedure and Surgical Access
Gastric resection can be performed as an open surgery (laparotomy) or as a minimally invasive procedure (laparoscopy). The laparoscopic approach offers advantages such as smaller incisions, reduced postoperative pain, and faster recovery when appropriate. The choice of approach depends on the underlying disease, the extent of resection, and the overall health of the patient.
Risks and Complications
As with any major surgical procedure, gastric resection carries certain risks:
- Anastomotic leak: leakage at the surgical connection between stomach and intestine
- Bleeding during or after surgery
- Infections or abscess formation in the abdominal cavity
- Dumping syndrome: rapid gastric emptying causing dizziness, weakness, and nausea
- Malnutrition due to reduced nutrient absorption
- Vitamin B12 deficiency due to the absence of intrinsic factor
- Osteoporosis resulting from calcium deficiency caused by reduced acid production
Aftercare and Nutrition
Following gastric resection, close follow-up care and long-term dietary adjustments are essential. Key measures include:
- Eating several small meals throughout the day instead of a few large ones
- Eating slowly and chewing thoroughly
- Lifelong supplementation of Vitamin B12 (via injection, as oral absorption is not possible without intrinsic factor)
- Supplementation of iron, calcium, Vitamin D, and other micronutrients
- Regular blood tests to monitor nutrient levels
- Oncological follow-up care in cases of cancer
References
- Siewert, J. R. & Stein, H. J. (Eds.): Surgery. 9th Edition. Springer Medizin Verlag, Heidelberg 2012.
- S3 Guideline on Gastric Cancer – Diagnosis and Treatment. AWMF Registration No. 032-009OL, current version.
- World Health Organization (WHO): Cancer – Stomach Cancer. Available at: https://www.who.int/news-room/fact-sheets/detail/cancer
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