Gastrectomy

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Gastrectomy refers to the surgical resection of the stomach. To maintain gastrointestinal function, gastrectomy must be followed by a form of reconstruction surgery, most commonly Roux-en-Y.

Indications

Types

Partial gastrectomy (also called distal or subtotal gastrectomy) refers to resection of only the distal part of the stomach. It may be used for gastric cancers in the distal 2/3rds of the stomach, when adjacent lymph nodes are also removed.

Total gastrectomy (also called radical gastrectomy) refers to complete removal of the whole stomach. It may be used for gastric cancers localised in the proximal stomach.

Sleeve gastrectomy refers to removal of 80% of the stomach, along the greater curvature. This decreases the size of the lumen, promoting satiety.

Reconstruction surgeries

An illustration of the Roux-en-Y reconstruction surgery

The Roux-en-Y reconstruction surgery is the most frequently performed reconstructive surgery of the proximal GI tract, as it prevents bile reflux. The stomach is separated from the bile-containing duodenum by a strand of jejunum 50 cm long. It is difficult to explain how this works, so I’ll allow this image to do the explaining.

Billroth

Billroth I refers to the procedure where the distalmost part of the stomach is resected, and an anastomosis is formed between the duodenum and the remaining distalmost part of the stomach in an end-to-end fashion. This can only be performed if the cancer is located distally in the stomach, close to the pylorus. This procedure is rarely performed anymore, and never in the surgical unit of POTE.

Billroth II refers to the procedure where a larger resection of the stomach is performed, and an anastomosis is formed between the side of the duodenum and the side of the remaining stomach in a side-to-side fashion. This procedure allows for a larger resection of the stomach than Billroth I. However, Billroth II allows bile to reflux into the stomach, which causes metaplasia and cancer progression in the remaining stomach or oesophagus. As such, Billroth II is rarely performed anymore, and never in the surgical unit of POTE.

Complications

Many complications may occur after gastric resection:

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