Gastrectomy

Page last reviewed: 13/07/2011

A gastrectomy is a medical procedure that involves surgically removing the stomach.

There are many types of gastrectomy including:

  • partial gastrectomy, where part of the stomach is removed
  • total gastrectomy, where the whole stomach is removed
  • sleeve gastrectomy, where the left side of the stomach is removed

See Gastrectomy - how it is performed for more information.

During a total gastrectomy, the surgeon connects the tube that runs between the throat and the stomach (oesophagus) to the small intestine. This means that the person will still have a working digestive system.

Why is a gastrectomy carried out?

A gastrectomy is often used to treat stomach cancer, also known as gastric cancer.

Less commonly, it used to treat:

  • stomach ulcers
  •  (open sores that develop on the inside lining of the stomach)
  • non-cancerous tumours
  • life-threatening obesity

See Gastrectomy - why it is used for more information.

Outlook

Removing some or all of the stomach does not affect the body's ability to digest food or liquid. However, after the operation, you may need to make changes to your diet, such as eating frequent, smaller meals rather than three large meals a day.

After a gastrectomy, some people will require vitamin supplements. This is because the stomach absorbs certain vitamins from food. See Gastrectomy - complications for more information.

Obesity

Obesity is when a person has an abnormally high amount of body fat.

Stomach

The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.

Ulcers

An ulcer is a sore break in the skin, or on the inside lining of the body.

Page last reviewed: 13/07/2011

Stomach cancer

A gastrectomy is one of the most effective ways of curing stomach cancer or slowing down the rate at which it spreads.

In most cases of stomach cancer, any tumours are too large to be cured with non-surgical methods, such as chemotherapy or radiotherapy (although these treatments are sometimes used to help make surgery more successful). Therefore, it is necessary to remove some or all of the stomach to prevent cancer cells spreading to other parts of the body.

If you have small tumours in the lower part of your stomach, you may only need a partial gastrectomy. However, if you have larger tumours in the middle of your stomach or if cancer cells have spread to nearby lymph nodes (small glands that are part of the immune system), it may be necessary to remove all of your stomach.

A gastrectomy may be recommended if you develop a non-cancerous (benign) tumour in your stomach. Even though the tumour is not cancerous, there is a significant risk that it could eventually become cancerous if it is not removed.

See the Health A-Z topic about Stomach cancer for more information.

Oesophageal cancer

A partial gastrectomy may be required to treat oesophageal cancer (cancer of the gullet) where it is thought that the cancer may have spread from the oesophagus to the top of the stomach.

See the Health A-Z topic about Oesophageal cancer for more information.

Stomach ulcers

A gastrectomy used to be a common treatment for stomach ulcers, also known as peptic ulcers. Nowadays, medicines such as proton pump inhibitors are usually used instead as they are an effective and less invasive treatment.

A gastrectomy is only used to treat stomach ulcers in very rare cases where they fail to respond to other treatments.

See the Health A-Z topic about Peptic ulcers for more information.

Obesity

Sleeve gastrectomy can be used to treat people with potentially life-threatening obesity.

Potentially life-threatening obesity is defined as:

  • having a body mass index (BMI) of 40 or above
  • having a BMI of 35 or above and having another serious health condition that could be improved if you lose weight, such as type 2 diabetes or high blood pressure 

Surgery involves reducing the size of the stomach by up to 75%, which means you can no longer eat large amounts of food, resulting in weight loss.

Sleeve gastrectomy is sometimes used when people are too obese to safely undergo other types of weight-loss surgery, such as a gastric bypass.

Obesity surgery is usually only offered if your obesity puts you at risk of developing life-threatening conditions, such as heart disease, and you have previously made significant efforts to lose weight with other methods.

Obese
Obesity is when a person has an abnormally high amount of body fat.
Stomach
The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.
Ulcer
An ulcer is a sore break in the skin or on the inside lining of the body.

Page last reviewed: 13/07/2011

Types of gastrectomy

There are many types of gastrectomy including:

  • partial gastrectomy
  • total gastrectomy
  • sleeve gastrectomy

Partial gastrectomy

A partial gastrectomy is carried out under general anaesthetic (painkilling medication that makes you unconscious). The surgeon will make an incision in your abdomen before removing the lower half of your stomach. Nearby lymph nodes are also usually removed because there is a risk that the cancer may have spread to the nodes.

Removing your lower stomach will expose your duodenum, the first part of the bowel. Your surgeon will stitch up your duodenum and move the upper part of your stomach down so that it can be connected to your bowel.

Total gastrectomy

As with a partial gastrectomy, this type of surgery is carried out under general anaesthetic. A surgical technique called Roux-en-Y surgery is often used to carry out a total gastrectomy for treating stomach cancer.

During the operation, your surgeon will make an incision in your abdomen before removing your stomach. They will then connect your oesophagus (the tube between your throat and stomach that food passes down) directly to your bowel.

Sleeve gastrectomy

A sleeve gastrectomy is also carried out under general anaesthetic. The surgeon will make an incision in your abdomen before removing the left side of your stomach. This can reduce your stomach's volume by up to 75%.

The remaining part of your stomach is pulled upwards and resealed, using stitches. This creates a much smaller and longer stomach that looks like a banana.

Techniques for gastrectomy

Two different techniques can be used to carry out a partial or total gastrectomy. These are:

Open gastrectomy

During an open gastrectomy, the surgeon makes a large incision in your abdomen to remove some or all of your stomach.

Keyhole surgery (laparoscopic gastrectomy)

The surgeon makes several smaller cuts in your abdomen, then uses a special telescope and small surgical instruments to remove some or all of your stomach.

A laparoscopic gastrectomy is also sometimes known as a laparoscopically assisted gastrectomy (LAG).

Deciding which procedure to have

There are pros and cons of each type of surgery.

People who have keyhole surgery usually recover more quickly and have less pain after the procedure than those who have an open gastrectomy. You may also be able to leave hospital slightly earlier. Complication rates after keyhole surgery are similar to those for open gastrectomies.

Keyhole surgery is an advanced surgical technique that requires specialised training and equipment. The operation may take longer if it is carried out using keyhole surgery.

Open gastrectomies are usually more effective in treating advanced stomach cancer compared with keyhole surgery. It may be easier to remove lymph nodes (small glands that are part of the immune system) during an open gastrectomy.

Before you decide which procedure to have, discuss the advantages and disadvantages of both techniques with your surgeon.

Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local) or to put a patient to sleep (general) during surgery.
Incisions
An incision is a cut made in the body with a surgical instrument during an operation.
Stomach
The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.

Page last reviewed: 13/07/2011

After the operation

After having a gastrectomy, you will be fitted with a nasogastric tube. This is a thin tube that passes through your nose and down into your stomach or small intestine. This will allow fluids produced by your stomach to be regularly sucked out, which will stop you feeling sick.

Until you can eat and drink normally, you will be fed through a tube inserted directly into a vein. Most people can begin eating a light diet about a week after having a gastrectomy.

After the operation, you will need to take painkillers for a few days. Tell your treatment team if the painkillers you are taking do not work because alternative painkillers are available. You will probably be able to return home one to two weeks after having a gastrectomy.

Adjusting to a new diet

Whatever type of gastrectomy you have, you will need to make changes to your diet. Food or drink that you enjoyed before the operation may give you indigestion. Many people find that keeping a food diary allows them to record the effects that certain types of food have on their digestion.

You will probably have to eat smaller meals more frequently for a fairly long time after having a gastrectomy. However, over time, your remaining stomach and small intestine will stretch and you will gradually be able to eat larger, less frequent meals.

High-fibre foods

Avoid eating high-fibre foods immediately after having a gastrectomy. They will make you feel uncomfortably full. High-fibre foods include:

  • wholegrain bread, rice and pasta
  • pulses, which are edible seeds that grow in a pod, such as peas, beans and lentils
  • oats, found in some breakfast cereals
  • fruit and vegetables

Over time, you will be able to gradually increase the amount of fibre in your diet.

Vitamins and minerals

If you have had a partial gastrectomy, you may be able to get enough vitamins and minerals from your diet by eating foods that are high in these nutrients. In particular, eat foods that are high in calcium, iron, vitamin C and vitamin D.

Foods that are high in calcium include:

  • milk
  • cheese
  • bread
  • eggs
  • fish that have edible bones, such as sardines
  • cabbage
  • broccoli

Foods that are high in iron include:

  • meat
  • liver
  • beans
  • nuts
  • dried fruit
  • leafy green vegetables, such as watercress

Foods that are high in vitamin C include:

  • broccoli
  • oranges
  • brussels sprouts
  • kiwi fruits
  • peppers

Foods that are high in vitamin D include:

  • oily fish
  • eggs
  • fortified foods that have had vitamin D added to them, such as margarine, breakfast cereals and powdered milk

Some people who have had a partial gastrectomy, and almost everyone who has had a total gastrectomy, will need regular injections of vitamin B12. This vitamin is difficult for your body to absorb from food.

Many people who have had a total gastrectomy may be unable to get enough iron, calcium, vitamin C and vitamin D from their diet, so they may require additional supplements.

After a gastrectomy, you will need regular blood tests to check that you are getting the correct amount of vitamins and minerals in your diet.

Intravenous
Intravenous (IV) means the injection of blood, drugs or fluids into the bloodstream through a vein.
Stomach
The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.

Page last reviewed: 13/07/2011

Stomach cancer

When a gastrectomy is used to treat stomach cancer, the results are usually good.

Healthcare professionals use the term "five-year disease-free survival" to refer to people who are alive and well, and whose cancer has not returned, five years after having surgery.

One study found that the five-year disease-free survival rate for people who had a gastrectomy for early-stage stomach cancer was estimated to be 80%.

The five-year disease-free survival rate for people who have a gastrectomy for advanced stomach cancer was estimated to be 15%.

Many people who have a gastrectomy live for much longer than five years without the cancer returning.

Obesity

Sleeve gastrectomy has a good success rate for treating obesity.

One study found an average excess weight loss of 73% three years after surgery. "Excess weight loss" is a measurement based on your weight before surgery and your "ideal" weight.

Further research is needed to determine how effective sleeve gastrectomy is for the long-term treatment of obesity. In the same study, the average excess weight loss after six years was 57%, which suggests that some people regain some of the weight they lost initially.

To get the best results from a sleeve gastrectomy, it is very important to follow the instructions of your healthcare team about diet and exercise.

Stomach
The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.

Page last reviewed: 13/07/2011

As with any type of surgery, a gastrectomy carries some risks. Also, several complications can occur as a result of the changes to the way you digest food.

Cancer

Gastrectomies to treat stomach cancer have a higher risk of complications because most people who have this type of surgery are elderly and often in poor health.

Complications can also occur after a gastrectomy to treat oesophageal cancer. The oesophagus is the tube that connects your throat to your stomach.

Possible complications of a gastrectomy include:

  • wound infection
  • leaking from where the stomach has been closed or re-attached to the small intestine
  • stricture, where stomach acid leaks up into your oesophagus and over time causes scarring, which leads to your oesophagus becoming narrow and constricted
  • chest infection
  • internal bleeding
  • blockage of the small bowel

An infection can usually be treated with antibiotics, but some other complications will require further surgery. Before your operation, ask your surgeon to explain the possible risks and how likely they are to affect you.

It is estimated that fewer than 2 in 100 people die from complications of a gastrectomy for stomach cancer or another stomach condition.

Obesity

Possible complications of a gastrectomy for obesity include:

  • nausea and vomiting, which usually get better over time
  • internal bleeding, which can lead to blood clots forming
  • leaking from where the stomach has been closed
  • acid reflux, where stomach acid leaks back up into the oesophagus
  • infection

It may be possible to treat some complications with medication, but others may need further surgery. Before your operation, ask your surgeon to explain the possible risks and how likely they are to affect you.   

The risk of death from a gastrectomy for obesity is very low, estimated as less than 1 in 100.

Vitamin deficiency

One function of your stomach is to absorb vitamins, particularly vitamins B12, C and D, from the food you eat.

If your entire stomach has been removed, you may not get all the vitamins your body needs from your diet. This may lead to certain health conditions, such as:

Anaemia 

The body requires vitamin B12 to make healthy blood cells. Without enough healthy blood cells, you could develop symptoms of anaemia, such as tiredness and breathlessness.

Increased vulnerability to infection

Vitamin C helps strengthen your immune system (the body's natural defence against infection and illness). If you do not have enough vitamin C in your diet, you may develop frequent infections. Wounds or burns will also take longer to heal.

Brittle bones (osteoporosis) and weakened muscles

Your body needs vitamin D to keep both your bones and muscles healthy and strong. If there is not enough vitamin D in your diet, you could develop pain and weakness in your bones and muscles.

Changing your diet may help compensate for your stomach's inability to absorb vitamins. However, even after changing your diet, you may need vitamin supplements. The healthcare professionals treating you can advise you about this. See Gastrectomy - recovery for more information about diet and supplements.

Weight loss

Immediately after surgery, you may find that eating even a small meal makes you feel uncomfortably full. This could lead to weight loss. Losing weight may be desirable if you have had a gastrectomy because you are obese, but it can be a health risk if you have been treated for stomach cancer.

Some people who have a gastrectomy regain weight once they have adjusted to the effects of surgery and have changed their diet. However, if you continue to lose weight, see a dietitian (a healthcare professional who specialises in nutrition). A dietitian can give you advice about how to increase your weight without upsetting your digestive system.

Dumping syndrome

Dumping syndrome is a set of symptoms that can affect people after a gastrectomy. It is caused when particularly sugary or starchy food moves suddenly into your small intestine.

Before a gastrectomy, your stomach digested most of the sugar and starch. However, after surgery, your stomach can longer do this, so your small intestine has to draw in water from the rest of your body to help break down the food.

The amount of water that enters your small intestine can be as much as 1.5 litres (3 pints). Much of the extra water is taken from your blood, which means that you will experience a sudden fall in blood pressure.

The drop in blood pressure can cause symptoms such as:

  • faintness
  • sweating
  • palpations
  • a need to lie down

The extra water in your small intestine will cause symptoms such as:

  • bloating
  • rumbling stomach
  • nausea
  • indigestion
  • diarrhoea

If you have dumping syndrome, resting for 20-45 minutes after eating a meal may help. To ease the symptoms of dumping syndrome:

  • Eat slowly.
  • Avoid sugary foods, such as cakes, chocolate and sweets.
  • Slowly add more fibre to your diet.
  • Avoid soup and other liquid foods.
  • Eat smaller, more frequent meals.

For most people, the symptoms of dumping syndrome improve over time.

Morning vomiting

After a partial gastrectomy, a small number of people may experience morning vomiting.

Vomiting occurs when bile, a fluid used by the digestive system to break down fats, and digestive juices build up in your duodenum overnight, before spilling back into what remains of your stomach. The duodenum is the first part of your small intestine. Due to its reduced size, your stomach is likely to feel uncomfortably full and this will trigger a vomiting reflex to get rid of the excess fluids and bile.

Taking indigestion medication, such as aluminium hydroxide, may help reduce the symptoms of morning vomiting. See your GP if your symptoms are particularly troublesome.

See the Health A-Z topic about Indigestion for more information.

Diarrhoea

During a gastrectomy, it is sometimes necessary to cut a nerve called the vagus nerve. The vagus nerve helps control the movement of food through your digestive system.

Although the vagus nerve will heal after surgery, a small number of people will experience bouts of severe diarrhoea. However, they usually only occur now and again and should pass within a day or so.

Taking an anti-diarrhoea medication, such as loperamide, in the morning may help reduce your symptoms.

See the Health A-Z topic about Diarrhoea for more information.  

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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