Gastrectomy
Encyclopedia
A gastrectomy is a partial or full surgical removal of the stomach
.
In severe duodenal ulcers it may be necessary to remove the lower portion of the stomach called the pylorus
and the upper portion of the small intestine
called the duodenum
. If there is a sufficient portion of the upper duodenum remaining a Billroth I procedure is performed, where the remaining portion of the stomach is reattached to the duodenum before the bile duct
and the duct of the pancreas
. If the stomach cannot be reattached to the duodenum a Billroth II
is performed, where the remaining portion of the duodenum is sealed off, a hole is cut into the next section of the small intestine called the jejunum
and the stomach is reattached at this hole. As the pylorus is used to grind food and slowly release the food into the small intestine, removal of the pylorus can cause food to move into the small intestine faster than normal, leading to gastric dumping syndrome
.
operation. Resection of 2/3 of the stomach with blind closure of the duodenal stump and retrocolic anastomosis
of the full circumference of the open stomach to jejunum
.
Another major effect is the loss of the intrinsic factor secreting parietal cells in the stomach lining. Intrinsic factor is essential for the uptake of vitamin B12
and without it the patient will suffer from a vitamin B12 deficiency
. This can lead to a type of anemia known as pernicious anemia
which severely reduces red-blood cell synthesis (known as erythropoiesis
). This can be treated by giving the patient direct injections of vitamin B12.
in 1881 for cancer of the stomach.
Historically, gastrectomies were used to treat peptic ulcer
s. These are now usually treated with antibiotic
s, as it was recognized that they are usually due to Helicobacter pylori
.
In the past a gastrectomy for peptic ulcer disease was often accompanied by a vagotomy
, to reduce acid production. Nowadays, this problem is managed with proton pump inhibitor
s.
Stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
.
Indications
Gastrectomies are performed to treat cancer and perforations of the stomach wall.In severe duodenal ulcers it may be necessary to remove the lower portion of the stomach called the pylorus
Pylorus
The pylorus is the region of the stomach that connects to the duodenum . It is divided into two parts:* the pyloric antrum, which connects to the body of the stomach.* the pyloric canal, which connects to the duodenum....
and the upper portion of the small intestine
Small intestine
The small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to...
called the duodenum
Duodenum
The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of duodenum...
. If there is a sufficient portion of the upper duodenum remaining a Billroth I procedure is performed, where the remaining portion of the stomach is reattached to the duodenum before the bile duct
Bile duct
A bile duct is any of a number of long tube-like structures that carry bile.Bile, required for the digestion of food, is excreted by the liver into passages that carry bile toward the hepatic duct, which joins with the cystic duct to form the common bile duct, which opens into the intestine.The...
and the duct of the pancreas
Pancreas
The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as a digestive organ, secreting pancreatic juice containing digestive enzymes that assist...
. If the stomach cannot be reattached to the duodenum a Billroth II
Billroth II
Billroth II, more formally Billroth's operation II, is an operation in which the greater curvature of the stomach is connected to the first part of the jejunum in a side-to-side manner. This often follows resection of the lower part of the stomach . The antrectomy is not part of the orignially...
is performed, where the remaining portion of the duodenum is sealed off, a hole is cut into the next section of the small intestine called the jejunum
Jejunum
The jejunum is the middle section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms middle intestine or mid-gut may be used instead of jejunum.The jejunum lies between the duodenum...
and the stomach is reattached at this hole. As the pylorus is used to grind food and slowly release the food into the small intestine, removal of the pylorus can cause food to move into the small intestine faster than normal, leading to gastric dumping syndrome
Gastric dumping syndrome
Gastric dumping syndrome, or rapid gastric emptying is a condition where ingested foods bypass the stomach too rapidly and enter the small intestine largely undigested. It happens when the upper end of the small intestine, the duodenum, expands too quickly due to the presence of hyperosmolar food...
.
Polya's operation
A type of posterior gastroenterostomy which is a modification of the Billroth IIBillroth II
Billroth II, more formally Billroth's operation II, is an operation in which the greater curvature of the stomach is connected to the first part of the jejunum in a side-to-side manner. This often follows resection of the lower part of the stomach . The antrectomy is not part of the orignially...
operation. Resection of 2/3 of the stomach with blind closure of the duodenal stump and retrocolic anastomosis
Anastomosis
An anastomosis is the reconnection of two streams that previously branched out, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....
of the full circumference of the open stomach to jejunum
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 gastric dumping syndromeGastric dumping syndrome
Gastric dumping syndrome, or rapid gastric emptying is a condition where ingested foods bypass the stomach too rapidly and enter the small intestine largely undigested. It happens when the upper end of the small intestine, the duodenum, expands too quickly due to the presence of hyperosmolar food...
.
Another major effect is the loss of the intrinsic factor secreting parietal cells in the stomach lining. Intrinsic factor is essential for the uptake of vitamin B12
Vitamin B12
Vitamin B12, vitamin B12 or vitamin B-12, also called cobalamin, is a water-soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins...
and without it the patient will suffer from a vitamin B12 deficiency
Vitamin B12 deficiency
Vitamin B12 deficiency or hypocobalaminemia is a low blood level of vitamin B12, it can cause permanent damage to nervous tissue as a long term effect. Vitamin B12 was discovered from its relationship to the disease pernicious anemia, which is an autoimmune disease that destroys parietal cells in...
. This can lead to a type of anemia known as pernicious anemia
Pernicious anemia
Pernicious anemia is one of many types of the larger family of megaloblastic anemias...
which severely reduces red-blood cell synthesis (known as erythropoiesis
Erythropoiesis
Erythropoiesis is the process by which red blood cells are produced. It is stimulated by decreased O2 in circulation, which is detected by the kidneys, which then secrete the hormone erythropoietin...
). This can be treated by giving the patient direct injections of vitamin B12.
History
The first successful gastrectomy was performed by Theodor BillrothTheodor Billroth
Christian Albert Theodor Billroth was a German-born Austrian surgeon and amateur musician....
in 1881 for cancer of the stomach.
Historically, gastrectomies were used to treat peptic ulcer
Peptic ulcer
A peptic ulcer, also known as PUD or peptic ulcer disease, is the most common ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. It is defined as mucosal erosions equal to or greater than 0.5 cm...
s. These are now usually treated with antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s, as it was recognized that they are usually due to Helicobacter pylori
Helicobacter pylori
Helicobacter pylori , previously named Campylobacter pyloridis, is a Gram-negative, microaerophilic bacterium found in the stomach. It was identified in 1982 by Barry Marshall and Robin Warren, who found that it was present in patients with chronic gastritis and gastric ulcers, conditions that were...
.
In the past a gastrectomy for peptic ulcer disease was often accompanied by a vagotomy
Vagotomy
A vagotomy is a surgical procedure that involves resection of the vagus nerve.-Applications:Truncal vagotomy is a treatment option for chronic duodenal ulcers...
, to reduce acid production. Nowadays, this problem is managed with proton pump inhibitor
Proton pump inhibitor
Proton-pump inhibitors are a group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production. They are the most potent inhibitors of acid secretion available today. The group followed and has largely superseded another group of pharmaceuticals with similar...
s.