The stomach has been completely removed so we can eat. Removal of the stomach for stomach cancer. What are the features of adaptation to normal life of people after removal of the stomach?

Modern ecology and the way of life of many people who prefer unhealthy snacks to full-fledged food from natural products, are the causes of gastrointestinal diseases. In case of late detection late stages pathologies require surgical treatment. Surgery is most often used to eliminate stomach cancer. There are several types of operations, selected according to the degree of damage and spread pathological process in the stomach and beyond. The classic operation lasts from 2 to 4 hours.

Indications and contraindications

The main reason for surgery is cancer of the gastric tissue. Removing part of the stomach or the entire organ with lymph nodes allows you to cut out the main part cancer cells, which reduces the risk of relapse. To consolidate the effect, compliance with postoperative recommendations such as diet, radiation and chemotherapy is required. Surgeries for stomach cancer are prohibited when:

there are metastases in separated organs, such as the liver, ovaries (in women), peritoneal pouch, lungs, supraclavicular and separated lymph nodes;
available large cluster free fluid in organs and abdominal space(ascites);
the body is severely exhausted, there is a large loss of weight with general weakness(cancer cachexia);
diagnosed with cancerous peritonitis, which involves the spread of pathological cells throughout the peritoneum;
there are diseases of the heart, blood vessels, kidneys;
Diagnosed with a hereditary bleeding disorder (hemophilia).

In the absence of contraindications, surgery for stomach cancer is performed regardless of age group. It is possible to prescribe radiation and chemical therapy, as a result of which the tumor shrinks, which increases the efficiency of its removal.

Types of operations for stomach cancer

The choice of the type of gastric surgery due to the removal of a malignant tumor is based on several criteria:

tumor location;
degree of metastasis;
number of metastases;
patient's age;
results of preoperative diagnostics.

Types of operations:

Resection or partial removal of tissue with a tumor.
Gastrectomy involves complete removal stomach cancer. Additionally, parts of the intestine or esophagus may be cut off.
Lymph dissection is characterized by cutting off the fat layer, lymph nodes, and blood vessels.
Palliative surgery is used to alleviate the general condition and progression of cancer in cases where the cancer is not operable. Patients live longer after using the technique.

The prognosis and survival rate after any surgery depends on the extent of the cancer and its extent.

How is resection done?

During the operation, either part of the organ or the entire organ is removed, depending on the lesion.

The method involves the complete removal of an organ or cutting off part of it. There are several techniques. Total excision or gastrectomy is used when:

the primary focus of cancer cells is located in the middle part of the stomach;
if all parts of the organ are affected.

The following are excised together with the stomach:

affected areas of the peritoneal fold that holds the organ;
whole or part of the pancreas;
spleen;
nearby lymph nodes.

After excision of the stomach, an anastomosis is performed, that is, the connection of the upper intestine with the duodenum and the esophagus for delivery digestive enzymes. The method refers to heavy operations. Survival rate, whether stomach cancer will disappear after surgery or not, how well the recovery will go digestive function and a person’s recovery depend on the accuracy of following the postoperative diet.

Selective proximal resection is used when the tumor is located in the upper half of the stomach. Appointed to in rare cases and with the following characteristics of the neoplasm:

size - less than 40 mm;
exophytic growth, that is, on the surface of the wall;
clear boundaries;
without damage to the serous membrane.

During resection, the upper affected area, 50 mm of the esophagus, and adjacent lymph nodes are cut off. A canal is formed connecting the esophagus to the operated stomach. Distal resection is prescribed for cancer in the lower region of the stomach. At the same time as the organ, the lymph nodes and parts of the duodenum are cut off. A gastroenteroanastomosis is formed to connect the organ stump with the small intestinal loop.

Gastrectomy

The operation is classified as a laparoscopic technique, which involves minimally invasive intervention. Produced in the following order:

A small incision is made on the abdominal wall.
An endoscope with a camera is inserted into the hole to examine the stomach and nearby structures.
Additional incisions are made.
A surgical instrument is inserted.
The affected tissues are excised.
The remaining parts are sutured.

Removal of the stomach for stomach cancer laparoscopic method performed in whole or in part using a special surgical knife. To improve vision, carbon dioxide is injected into the abdominal cavity. A camera located on the endoscope transmits the image to a monitor on which the surgeon can select an area to enlarge the image. This allows you to see the pathology and perform excision with high accuracy. The main advantages of laparoscopic gastrectomy:

minimal number of postoperative complications;
easier rehabilitation period.

Removal using lymph node dissection

The method refers to additional measures that involve cutting off nearby lymph nodes, choroid plexuses and adipose tissue. The extent of lymph node dissection depends on the degree of malignant lesion. There are several types of such operations:

Reduction of adipose tissue while preserving lymph nodes.
Cutting off nearby nodes to the greater and lesser omentum.
Excision of nodes in the midline of the affected organ.
Additional removal of structures near the celiac trunk.
Cutting off nodes around the aorta.
Removal of all lymph nodes and cancerous organs near the stomach.

Lymph node dissection is difficult to perform, but the risk of recurrence is much lower.

Palliative operations for stomach cancer include operations that temporarily alleviate the condition of patients.

Effects of using the method:

relief of symptoms;
reduction in the size of education;
reducing the risk of intoxication;
increasing the effectiveness of radiation and chemotherapy.

There are two types of palliative surgeries:

A method that allows you to create a bypass channel to the small intestine. The affected organ can be removed without affecting the lymph nodes and nearby tissues. Effects:
- improving the quality of nutrition;
- relief of general condition;
- improved tolerability of further treatment.
Complete removal of the tumor. The postoperative effect is an increase in the effectiveness of radiotherapy and chemotherapy.

Palliative care prolongs the lives of people with terminal cancer. The method is contraindicated when involved in oncological process mesentery, brain and bone marrow, lungs, peritoneal sheets.

Preparing for surgery

Preoperative preparation is needed to improve the psychological state and the functioning of the body as a whole:

Before performing surgical intervention, it is necessary to adhere to special diet.

A special diet consisting of pureed, liquid, easily digestible food. Dishes must contain the entire complex of vitamins.
Psychological preparation. Usually people are not told about cancer. Before the operation, they report a progressive gastric ulcer that needs urgent surgery.
Positive attitude of the patient. This requires the support of relatives.
Medication preparation involves taking:
- multivitamins;
- means that increase the functionality of the gastrointestinal tract;
- sedatives to improve sleep quality and psychological well-being;
- proteins and plasma to eliminate anemia;
- drugs that improve the functioning of the liver, kidneys, heart;
- antibiotics to relieve inflammation and reduce fever;
- hemostatic agents (if necessary).
Gastric lavage. A solution of furatsilin, potassium permanganate, hydrochloric acid. This must be done to completely empty the gastrointestinal tract.
Chemotherapy to reduce the size of tumor formation and stop metastasis.

Removal of the stomach is carried out mainly in the presence of extensive damage. Indications for such an operation are malignant neoplasm, serious damage, multiple polyps. The operation involves a high risk of complications, but if all instructions are followed, the prognosis is favorable. You can live as long without a stomach as with one. The exception is the tumor process, when the disease recurs.

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Indications for surgery

Indications for gastric removal surgery include:

organ perforation;
bleeding during peptic ulcer;
diffuse polyposis;
excessively high body mass index.

The main reason that makes doctors choose radical way treatment is stomach cancer. Gastrectomy is performed when the tumor is located in the cardiac or pyloric region. The stomach is completely removed if the cancer has affected the middle third of the organ. In this case, lymph nodes and other formations are additionally excised.

Other reasons lead to removal of the stomach much less frequently. Peptic ulcer disease is often treated with medication and requires radical surgery only in case of serious complications.

Multiple polyps on the gastric mucosa

With diffuse polyposis, formations are observed on the mucous membrane. The terminology "diffuse" means a plurality of them distributed over large areas. This leads to gastrectomy due to the inability to remove every polyp. These formations tend to degenerate into malignant ones.

Perforation of the organ wall occurs not only when affected by a tumor, but also against the background of trauma and requires urgent surgery (not always gastrectomy).

IN special group patients with excessive obesity. Sometimes the only way A method that helps reduce the amount of food consumed is partial or complete removal of the stomach.

Rarely, organ removal is carried out as a preventive measure - in case of a mutation of the CDH1 gene. This condition significantly increases the risk of developing genetically determined forms malignant tumors diffuse type stomach. In this case, patients are recommended to undergo preventive removal before cancer forms.

Contraindications

Contraindications are based on the complexity of the procedure and the likely significant amount of blood loss. Among them are the following:

Terminal stage cancer(damage to regional and distant lymph nodes, internal organs). Is inoperable.
The patient's serious condition.
Pathologies of internal organs, especially the lungs or heart.
Diseases accompanied by blood clotting disorders.

Preparatory measures

Before the operation it is necessary thorough examination sick. Conducted:

urine test;
tomography of the affected area;
blood test for biochemistry;
examination of stool for the presence of red blood cells;
Ultrasound of organs abdominal cavity;
gastroscopy to examine the gastric mucosa (usually the study is supplemented by the removal of a tissue sample for histological examination).

A planned operation includes a preliminary consultation with specialists of other profiles.

The preparatory stage includes the following measures:

1. Subject to availability cardiovascular pathologies, diabetes, bronchopulmonary disease, treatment must be adjusted so that the patient can tolerate anesthesia and surgery.
2. It is necessary to inform the attending surgeon about all medications taken. 7 days before surgery, stop using medications that thin the blood and reduce blood clots, as well as NSAIDs and medications containing acetylsalicylic acid.
3. If available increased risk infection, a course of antibiotic therapy is prescribed before surgery.
4. Patients who are preparing for surgery are prescribed a diet that prohibits the consumption of spicy, salty and fried foods, and alcohol. Smoking increases risk negative consequences problems that arise after surgery, so it is necessary to give up this habit.
5. After passing all the tests, if the patient’s condition does not prevent this, he is admitted to the hospital for preparation.
6. A day before gastrectomy, a light diet is prescribed.
7. It is prohibited to eat any food on the day of the operation; you are not even allowed to drink, so that the administration of anesthesia does not provoke vomiting.

Types of surgical intervention

A gastrectomy can mean either partial or complete removal of the stomach. There are several varieties:

An important part of the operation is mobilization of the stomach. Access to the organ is provided - this happens by cutting the ligaments and omentum. After this, the vessels are ligated and coagulated. The gastropancreatic ligaments are crossed along with the vessels that are located in them, which requires extreme caution. At the end of the operation, the esophagus and small intestine are connected.

For an ulcer that cannot be treated using medicinal methods, or in case of its complications, an operation is performed, not limited to total options. In the presence of diffuse processes, there is no need to remove omentums, lymph nodes and other organs, so the intervention is less traumatic for the patient. In severe cases, when the pathology is accompanied by extensive blood loss, the operation is performed urgently, without examination. The extent of intervention is determined by the surgeon during the procedure.

Possible complications

Removal of an organ cannot occur without consequences. The most likely occurrence of pathologies such as:

Anemia. After surgery, the diet changes, food digestion worsens, which leads to vitamin deficiency, accompanied by fatigue and drowsiness.
Bleeding and peritonitis- pathologies requiring urgent treatment.
Tumor recurrence. Cancer develops in the stump of the stomach and has more poor prognosis compared to the primary form.
Dumping syndrome. Caused by the low quality of food consumed. Sweating, increased heart rate, dizziness, and vomiting immediately after eating appear.
Reflux esophagitis. An inflammatory process in the esophagus caused by the reflux of small intestinal contents into it. Accompanied by abdominal pain, heartburn and nausea.

Often the surgical intervention itself and the period after the operation develop favorably, and complications arise much later, already at home.

Lifestyle after surgery

In the postoperative period, the patient requires help and care, which consists of the administration of painkillers. IN small intestine a special probe is installed. It performs the function of providing nutrition until the rehabilitation period has passed and oral food intake becomes possible. Injected through a probe special solutions. To replenish a sufficient volume of fluid, infusion therapy is performed.

Liquid food and water can only be consumed 48-72 hours after surgery. Before expanding the diet, it is necessary to assess how much the intestines have begun to function. If stool appears, you can gradually add pureed dishes, cereals and regular food.

Nutrition after surgery changes forever. Portions become small, meals become frequent, 6 to 8 times a day. This helps prevent complications such as dumping syndrome. Steamed or boiled food is preferable. You are allowed to drink no more than a glass of liquid at one time. Instead of water, you can drink teas and compotes.

Diet features

Protein must be present in the patient’s diet in sufficient quantities; simple and refined carbohydrates will have to be abandoned. Reducing fat is also preferable. It is necessary to completely abandon:

alcohol;
spices;
fried and smoked dishes;
canned food

Salt consumption is reduced to a minimum. Food must be chewed thoroughly. It should be at room temperature. If there are stool disorders, diet adjustments are recommended. For diarrhea, dishes with cereals (rice, buckwheat) are introduced into the diet; for constipation, prunes, kefir and yogurt, and beets.

You can switch to such a diet 30-40 days after organ removal, but complete rehabilitation takes about a year. How quickly a person recovers is influenced by his emotional state and mood:

If the patient worries too much and observes dietary restrictions for too long, the situation leads to vitamin deficiency, anemia and weight loss.
Some patients, on the contrary, cannot withstand the strict regime, begin to eat 3-4 times a day in large portions and forget about the ban on certain foods. This leads to disruption of the gastrointestinal tract and the development of complications.

After surgery, there is a lack of vitamins and microelements. In order to eliminate it, vitamin and mineral complexes are used. Vitamin B12 is prescribed, since when the stomach is removed, its natural absorption does not occur.

Physical activity shortens the rehabilitation period, stimulates the contractile activity of the remaining part of the organ, which leads to more rapid recovery. Movement prevents the formation of adhesions, the appearance of which is often associated with complications. Physical activity also reduces the risk of blood clots. But there are also some restrictions: the period immediately after surgical intervention, excessive activity, heavy lifting.

Forecast

The prognosis depends on the choice of surgical technique, the degree of cancer development and the general condition of the patient. If the operation went well, no complications were identified in the postoperative period, and the cancer process did not recur, the prognosis is favorable.

When predicting the effectiveness of treatment, age is also taken into account. In the elderly, removal of the stomach leads to an unfavorable outcome much more often. In young people, stomach cancer occurs predominantly in women. Men are more likely to get sick after reaching old age, so their prognosis is less favorable.

Treatment started when cancer develops to the first degree guarantees recovery in 85% of cases. At terminal stage only 15% of patients have a life expectancy of more than 5 years after surgery.

Hereditary diffuse gastric cancer is a type of cancer that is sometimes caused by a mutation in the CDH1 gene. Cancer cells are widespread or scattered throughout the stomach, making it difficult to detect at an early stage. To prevent the development of an aggressive form of stomach cancer, a gastrectomy (complete removal of the organ) is performed. If it is necessary to remove the stomach due to cancer, life expectancy largely depends on the qualifications of the surgeon, the absence of complications and adherence to diet after surgery.

The recommended treatment to prevent the development of an aggressive form of stomach cancer is gastrectomy (complete removal of the organ). It is also performed to treat some cancer diseases. People with other types of stomach cancer may also have a gastrectomy.

Surgeries for stomach cancer

Learn about the different types of surgery for stomach cancer. The type of surgery depends on where in the organ the cancer is located. Stomach surgery for cancer are serious method treatment. It is done under general anesthesia. The patient does not feel anything. The stomach may be partially or completely removed. The patient will not need an ostomy.

On early stages 1A cancer, the surgeon may remove the stomach lining. He removes the mucous using a long flexible tube (endoscope). The procedure is called endoscopic gastrectomy - this is the removal of part of an organ or mucous membrane. As a rule, the lower half of the stomach is removed, the remaining part is connected to the intestines.

Gastrectomy before and after

The part of the small intestine that is first cut at the lower end duodenum, extends straight upward towards the esophagus. The end of the duodenum is reconnected to the small intestine. The entire procedure usually takes 4-5 hours, after which the patient's stay in the hospital is 7-14 days.

Often, patients are advised to avoid food and drink for the first 3-5 days, and tampons are moistened to relieve dry lips and mouth. New system digestion can be fatal if the connection between the rectum and esophagus remains leaking.

Often used to check for leaks test x-rays before resuming drinking and eating. The first 2-4 weeks after surgery will be not an easy task. It may be uncomfortable or painful to eat, but this is a normal part of the healing process. Some surgeons insert feeding tubes to supplement nutrition for a period of time after surgery—something to discuss before surgery.

Removal of part of the stomach

Up to 2/3 of the stomach is removed if the cancer is in the lower abdomen. How much is removed depends on the spread of the cancer. The surgeon will also remove some of the tissue that holds the organ in place. As a result, the patient will have a smaller organ.

Removal of the stomach and part of the esophagus

This operation is performed if the cancer is in the area where the stomach connects to the esophagus. In this case, the surgeon removes the organ and part of the esophagus.

Removal of lymph nodes

During the operation, the surgeon examines the organ and the surrounding space. If necessary, remove all lymph nodes located near the stomach and along major blood vessels if they contain cancer cells. Removing nodes reduces the risk of cancer returning. There are cases when the cancer comes back after surgery, then chemotherapy is required or, if possible, a second operation.

Types of surgery

Open surgery

The type of surgery depends on where the cancer is in the stomach. Removal of the stomach for cancer is usually done by open surgery.

Subtotal gastrectomy is an operation through an incision in the abdomen.
A total gastrectomy with reconstruction, where the surgeon makes one incision in the abdomen to remove the entire stomach and all omentums. The surgeon attaches the esophagus to the duodenum.
Thoracoabdominal gastrectomy – the stomach and esophagus are removed through an incision in the abdomen and chest.

Laparoscopic surgery

This is an operation without the need for a large incision in the abdomen. For stomach removal surgery may be required keyhole. This type of surgery is done in specialized centers by specially trained surgeons. The surgeon makes 4 to 6 small cuts in the abdomen. A long tube called a laparoscope is used.

The laparoscope is connected to a fiber-optic camera, which displays photographs of the inside of the body on a video screen. Using a laparoscope and other instruments, the surgeon removes part or all of the stomach. Then the remaining organ is connected to the intestines, or the esophagus is connected to the intestines if the entire organ is removed. Laparoscopic surgery takes 30 to 60 minutes.

The most common way to remove a major organ is open surgery.

Less invasive procedures include:

treatment and blood tests to monitor indicators;
dietary food;
light exercise;
consultation with an oncologist and nutritionist.

At home after surgery, it is necessary to work towards regulating nutrition, allowing the body to adapt to the loss of the stomach. At the same time, it is important to consume as many calories as possible to minimize rapid weight loss during the first few months after surgery, as well as take in the nutrients the body needs to help with the healing process.

Possible complications after stomach removal

As with any type of surgery, there is a risk of complications. Problems may arise due to changes in the way food is digested. There may be the following main complications: weight loss, dumping syndrome, blockage of the small intestine, vitamin deficiency and others. Some complications can be treated with medication, otherwise another operation will be required.

One of the functions of the stomach is to absorb vitamins in food (especially B12, C and D). If the organ is removed, the person may not be able to get all the vitamins, which can lead to anemia and vulnerability to infection. Vitamin C helps strengthen immune system(the body's natural defense against infection and disease).

If the body does not have enough vitamin C, it can develop frequent infections. Wounds or burns will also take longer to heal. As a result of vitamin D deficiency, bone osteoporosis can develop.

Immediately after surgery, the patient may experience discomfort when eating. People who have a gastrectomy must adapt to the effects of the operation and change their diet. A nutritionist can give advice on how to increase your weight with an unusual digestive system. Dumping syndrome is a set of symptoms that can affect people after surgery.

The amount of water gradually increases to 1.5 liters per day. Most of the extra water comes from the blood, which means a fall is possible. blood pressure.

A decrease in blood pressure causes symptoms: nausea, hyperhidrosis, rapid heartbeat. In this state you need to lie down.

Excess water in the body causes symptoms: flatulence, stomach rumbling, nausea, upset, diarrhea.

If you have dumping syndrome, resting for 30 minutes after eating may help. In order to alleviate the symptoms of dumping syndrome, you need to:

eat slowly;
avoid sweet foods;
gradually add more fiber to your diet;
eat less, more frequent appointments food.

Removal of the stomach for cancer - 65% of people overcome the lifespan of 5 years. In the final stages, 34% survive to the five-year mark. If a person applies at the last stage, after diagnosis he can live only six months.

Informative video

All materials on the site were prepared by specialists in the field of surgery, anatomy and related disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Removal of the stomach is considered very traumatic surgery, it is produced according to special indications, but, at the same time, it is the most effective way get rid of some diseases. The risks of the operation are high, and the intervention itself requires good preparation and stable condition of the patient.

Before deciding whether to completely remove the stomach, the doctor will always weigh the pros and cons, evaluate the consequences and benefits for the patient, who may lose a very important organ forever.

The stomach is not just a muscular “bag” into which food enters for digestion. It prepares the contents for further movement into the intestines, breaks down some food components, and produces biologically important active substances, regulates hematopoiesis. When such an important organ is removed, not only digestion in general is disrupted, but also many metabolic processes.

Indications for surgery are limited, and almost always, if possible, the surgeon will try to choose more gentle treatment methods, which involve leaving the part of the organ in which secretory activity is concentrated. According to statistics, every tenth patient risks dying after undergoing surgery, but modern technologies and the high qualifications of the doctor help reduce this likelihood.

Who needs surgery?

Indications for stomach removal:

Malignant tumor;
Diffuse polyposis;
Chronic ulcer with bleeding;
Perforation of the organ wall;
Extreme obesity.

The main reason for resorting to stomach removal is malignant tumors. Stomach cancer is one of the most common species neoplasms, affecting humans, is most common in Japan and Asia, but its incidence continues to increase in other regions. The presence of a tumor, especially in the middle third, cardiac or pyloric region, is considered a direct indication for gastrectomy, which is supplemented by removal of lymph nodes and other formations of the abdominal cavity.

Much less often, doctors perform surgery to remove the stomach for other reasons. For example, peptic ulcer It is usually treated conservatively by gastroenterologists, but its complications, such as perforation or persistent massive bleeding, may require radical surgery.

Diffuse polyposis when polyps are multiple and scattered over the entire area of the gastric mucosa, it is also an indication for gastrectomy, because it is not possible to remove every polyp, and their presence is fraught with malignant transformation. Wall perforation stomach not only of ulcerative origin, but also due to trauma, requires emergency intervention, which may result in gastrectomy.

A special group of patients consists of overweight people, when the only way to limit the amount of food eaten is to remove the fundus and body of the stomach.

In very rare cases, gastrectomy can be prophylactic, in particular when carrier of the geneCDH1, in which a mutation has occurred that predetermines hereditary form diffuse cancer stomach. For such individuals, the doctor may recommend preventive removal of the organ while cancer has not yet formed.

Considering the large volume of intervention, possible blood loss during surgery, and prolonged anesthesia, there are contraindications to this type of surgical treatment:

Cancer with metastases internal organs and lymph nodes (inoperable tumor);
Severe general condition of the patient;
Decompensated pathology from the outside cardiovascular system, lungs and other organs;
Bleeding disorders (hemophilia, severe thrombocytopenia).

Preparing for gastrectomy

Such complex operation, like gastric removal, requires careful preoperative examination of the patient and treatment of concomitant diseases.

Before the planned operation you will need:

General and biochemical tests blood;
Urinalysis;
Examination of feces for occult blood;
Fluorography or chest x-ray;
Ultrasound examination of the abdominal organs;
CT, MRI of the affected area;
Fibrogastroscopy to examine the inner lining of the stomach, determine the nature of tumor growth, etc., which is usually supplemented by a biopsy.

Before the operation, if it is carried out as planned, you will have to undergo consultations with a number of specialists, starting with a therapist. In the presence of heart and vascular diseases (hypertension, ischemic disease), diabetes mellitus, chronic bronchopulmonary pathology, their treatment must be adjusted so that the patient can safely undergo anesthesia and the operation itself.

Patients taking any medications should notify their doctor. and a week before gastrectomy, you should stop taking blood thinning and antithrombotic drugs (anticoagulants), non-steroidal anti-inflammatory drugs, and aspirin. At high risk infectious complications in preoperative period antibiotics are prescribed.

Diet and lifestyle should also be reviewed. Patients preparing for complete removal of the stomach need a gentle diet, excluding spicy, salty, fried foods, and alcohol. Smokers should think about how to quit the addiction, which increases the risk of dangerous postoperative complications.

When all the necessary examinations have been completed, the patient’s condition is stable and does not interfere with the operation, he is admitted to the hospital. The day before gastrectomy, the diet should be especially light, and from midnight it is forbidden to consume food and water, not only because of possible fullness of the stomach, but also due to possible vomiting during anesthesia.

Types of gastric removal operations

Gastrectomy usually involves the complete removal of the stomach, but it is also possible to leave small parts of the organ. Removal of the stomach includes several types of operations:

Distal subtotal gastrectomy, when most of the stomach is removed, passing into the intestines.
Proximal subtotal gastrectomy, used for tumors of the upper third of the organ, when the proximal fragment of the stomach with the lesser curvature, both omentums, and the lymphatic system must be removed.
Total gastrectomy - the entire stomach is removed and the esophagus is connected to small intestine.
Sleeve gastrectomy.

Main stages of gastrectomy

Introducing the patient into anesthesia (endotracheal plus muscle relaxants).

Opening the abdominal cavity transabdominally (through the anterior abdominal wall), transthoracically (through pleural cavity), thoracoabdominal (combination of both approaches).
Examination of the abdominal cavity.
Mobilization of the stomach.
The connection between the esophagus and the intestines.

Mobilization of the stomach- a very important part of the operation, in which the surgeon provides access to the organ by cutting the ligaments, omentum, cutting and suturing the small intestine. Crossing the gastropancreatic ligament simultaneously with the vessels located there is the most significant stage, requiring extreme caution and attentiveness. As the ligament is dissected, the surgeon also ligates the vessels.

Gastrectomy is completed by making a connection between the esophagus and the small intestine, most often in an end-to-side manner. Anastomosis“end to end” is rarely applied when there is a long esophagus or section of the small intestine to be connected.

Progress of cancer surgery

Since the main indication for gastrectomy is a malignant tumor, most often doctors are forced to remove the entire organ and some surrounding structures at once. Surgery to remove the stomach for cancer has its own characteristics related to its prevalence tumor process and damage to neighboring tissues.

A gastrectomy is performed under general anesthesia and can take up to five hours. The patient is installed urinary catheter and nasogastric tube. In oncology the most appropriate open views operations, abdominal access is preferable, implying a fairly large incision in the abdominal cavity. Of course, this is more traumatic, but it gives the surgeon the opportunity to thoroughly examine the affected area and remove all affected tissue.

After opening the abdominal cavity, the doctor inspects the organs, and then proceeds with a gastrectomy, removing in a single block the stomach, both omentums, gastric ligaments, fatty tissue, and lymph nodes, according to the stage of the disease. If the tumor has spread significantly, resection of the pancreas, part of the esophagus, liver, and spleen may also be required.

The final stage of total gastrectomy for cancer is the reunification of the small intestine with the esophagus. All stages of the operation are carried out with strict adherence to the principles of ablastics to prevent the spread of cancer cells (early ligation of blood vessels, change of linen and gloves, etc.). An oncologist surgeon must be very careful, because even the most modern methods diagnostics do not always provide accurate information about the spread of the tumor, and upon direct examination, the doctor may detect additional foci of cancer that require expansion of the operation.

In some cases of oncological pathology, laparoscopic access is possible, when the stomach is removed through a small incision on the abdominal wall. Laparoscopy is much less traumatic than open surgery; modern equipment allows it to be performed safely and effectively, but difficulties may arise with the removal of lymph nodes, so the possibility of such an operation is decided individually with each patient.

Gastrectomy for ulcers and other non-neoplastic lesions

For chronic peptic ulcer disease that cannot be treated conservative ways, or in case of its complications, a gastrectomy is also performed, trying to limit oneself to subtotal versions of the operation or removal of part of the stomach (resection). In addition, in case of non-oncological processes (diffuse polyposis, Zollinger-Ellison syndrome), there is no need to remove omentums, lymph nodes and areas of other organs, so the intervention is generally more gentle and less traumatic for the patient.

If the operation is performed as an emergency due to massive bleeding, then there is simply no time for examination, so the surgeon has to determine the required volume of intervention directly during the operation.

Sleeve gastrectomy

A special type of surgery to remove the stomach is the so-called sleeve gastrectomy, which is indicated for patients with severe obesity. To reduce the amount of food that the patient can eat, the surgeon removes the body and fundus of the stomach, leaving only a narrow canal at the lesser curvature of the organ. When eating even a small amount of food, the remaining fragment of the stomach quickly fills, and a feeling of fullness sets in, and the patient stops eating.

Sleeve gastrectomy is widely practiced throughout the world and shows good result. Persistent weight loss is observed in most patients, but further dietary restrictions cannot be avoided.

Complications of gastrectomy and possible consequences

Removal of an entire organ, in this case the stomach, cannot go unnoticed by the patient. The risk of complications is quite high, and the consequences are not limited to impaired digestion of food. Most likely:

Reflux esophagitis;
Anemia;
Loss of body weight;
Dumping syndrome;
Tumor recurrence in the gastric stump;
Bleeding and peritonitis.

Bleeding and peritonitis– spicy surgical pathology requiring urgent treatment. Typically, such complications are caused by failure of the sutures placed on the vessels and intestinal walls when removing the stomach.

If the operation itself and the early postoperative period are favorable, after discharge home the patient may encounter a number of other consequences of treatment. So, reflux esophagitis consists of inflammation of the esophagus when intestinal contents with bile acids and enzymes are thrown into it, which is manifested by pain, heartburn, and nausea.

Dumping syndrome is caused by an inadequate amount of food consumed and is manifested by tachycardia, sweating, dizziness, and vomiting immediately after eating.

The vast majority of patients who have undergone gastrectomy, regardless of the reason for the operation, suffer from a lack of vitamins, microelements, nutrients, which is manifested by weight loss, weakness, drowsiness, etc. Anemia is associated with a lack of factors produced by the gastric mucosa and enhancing the formation of red blood cells.

Lifestyle after surgery and prevention of complications

In the postoperative period, the patient may require care and assistance, consisting of the administration of painkillers, nutritional mixtures through a tube, and intravenous fluids. Until the moment it becomes possible reception food through the mouth, special solutions are prescribed intravenously or through a tube inserted into the small intestine. Infusion therapy is performed to replenish the missing fluid.

Approximately 2-3 days after the operation, the patient is asked to drink liquid and try liquid food. If everything is fine, the intestines have begun to function, then the diet gradually expands from liquids to cereals, pureed dishes and then to eating regular food.

Nutrition after gastrectomy is of particular importance. Patients who have undergone surgery are advised to eat small meals up to 6-8 times a day to prevent the possibility of dumping syndrome and digestive disorders. Large amounts of food should be avoided.

The diet after removal of the stomach should be gentle, It is better to steam or boil dishes, preferably a sufficient amount of protein, reducing the proportion of fats and avoiding easily digestible carbohydrates (sugar, sweets, honey). After removing the stomach from the diet, you will have to exclude spices, alcohol, hot and fried foods, smoked meats, pickles, reduce salt consumption. Food should be well chewed, not cold, but not hot.

If intestinal function is impaired in the form of diarrhea, dishes with rice, buckwheat are recommended, and for constipation - prunes, fermented milk products, boiled beets. It is allowed to drink tea and compotes, but the amount should not exceed 200 ml at one time, and it is better to divide it into 2-3 parts.

The deficiency of vitamins and microelements that inevitably occurs after removal of the stomach is compensated by taking them in the form medicines. Vitamin B12 must be prescribed, since in the absence of the stomach its absorption does not occur, which is fraught with the development of pernicious anemia.

You can switch to the described diet a month to a month and a half after removal of the stomach, but rehabilitation usually takes about a year. Of particular importance is the psychological status and mood of the patient. Thus, excessive anxiety and suspiciousness can lead to long-term unjustified restrictions in the diet, resulting in weight loss, anemia, and vitamin deficiency. There is another extreme: the patient cannot maintain the regime, reduces meals to three or four times a day, begins to eat prohibited types of foods, which leads to digestive disorders and the development of complications.

For early activation and stimulation of intestinal function, good motor activity. The sooner the patient gets up after surgery (within reason, of course), the lower the risk of thromboembolic complications and the faster the recovery.

With a correct and timely operation, adequate rehabilitation and compliance with all doctor’s recommendations, patients after gastrectomy live as long as everyone else. Many adapt to new conditions of digestion and behave quite active image life. The situation is worse in patients who have undergone surgery for cancer. If the tumor is detected promptly at an early stage, then the survival rate reaches 80-90%, in other cases this percentage is much lower.

Prognosis after gastric removal as well as life expectancy, depend on the reason for which the operation was performed, the general condition of the patient, and the presence or absence of complications. If the organ removal technique was not violated, complications were avoided and no relapse occurred malignant tumor, then the prognosis is good, but the patient will have to make every effort to ensure that the body receives the substances it needs in full, and digestive system, deprived of a stomach, did not suffer from an unbalanced diet.

Video: gastrectomy – medical animation

Gastric resection is a surgical procedure that involves partial or complete removal of this organ.

The essence of the methodology

This radical method is prescribed to patients to fight cancer or ulcers. Surgery is a complex and lengthy process, but remains a common option for solving the problem.

Advice: Even a successful operation affects your health. To cope with complications, carefully follow all the recommendations of your doctor and eat right.

The rehabilitation process is long, during which physical activity is not allowed.

Causes of the disease

The operation is prescribed after a series of tests. The decision is made collectively, everyone is considered possible options solving the problem, since it is important to make life easier for the patient. The main reasons for prescribing resection include:

severe degree of cicatricial stenosis;
perforation (through hole) of the stomach walls;
duodenal or gastric ulcer;
the presence of polyps that contribute to the development of cancer;
severe obesity.

Depending on the risk and severity of the above diseases, a decision is made on the size of the part of the stomach removal. The most severe consequences can occur after cancer. But in mild stages you can limit yourself.

Results after surgery

The results and success of the operation depend on a number of factors:

reasons for surgery;
in case of cancer, the stage of neglect;
general condition of the patient, etc.

As already noted, the most serious illness, which leads to resection, is cancer. Many people are concerned about how long a person can live after surgery. If cancer is detected in the early stages, the survival rate is about 90% within 5 years. During this time, the patient continues to lead his usual lifestyle, eat his usual food (with minor adjustments and restrictions). At the same time, he retains his usual appetite. Many patients live for many more decades.

After the operation, the main task is to restore digestive process. When peristalsis is normalized, the patient begins to gradually take his usual food - first in liquid and crushed form, then in solid form. The attending physician indicates forbidden foods and describes what and how much you can consume daily.

As a rule, the hospitalization process lasts 7-14 days and depends on the individual qualities of the body, the patient’s requirements and even the psychological state.

fractional meals;
eating small portions;
eating protein foods with low sugar content.

Extract

Undoubtedly, the stomach plays a key role in the digestive process. But even if it is partially removed, the body still takes on all the assigned tasks and continues to actively carry them out.

If total removal is performed, the esophagus is combined with the small intestine. At the junction, a reservoir is created for food that comes from the esophagus. Gradually, the body adapts to the changes and restores the digestive process, and patients live as before. Recovery takes several months

Advice: The more clearly you follow all the recommendations of your doctor, the sooner you can begin your normal lifestyle.

In the first 6-9 weeks, the patient is strictly prohibited from physical activity. It is recommended to engage in special gymnastics or light physical activity.

The average duration of the recovery process ranges from several weeks to several months. After surviving cancer, the patient continues regular monitoring with a doctor.

Results

During surgery, a new anatomical environment for digesting food is formed in the body. Food passes through the remains of the stomach or created reservoir quickly, and the absorption of nutrients occurs in the intestines.

But the process of rehabilitation and recovery is not easy, sometimes it is accompanied by serious consequences and complications. Unfortunately, this trend is not uncommon.

Advice: do not lose your vigilance and constantly monitor your condition, following your doctor’s recommendations. Even after several years, sudden pain syndromes at the site of surgery, bilious vomiting or even ulcerative relapses in the intestinal area.

If solid, poorly crushed food enters the intestines, the patient may experience loss of strength, dizziness, and palpitations. Failure to comply may result in loss of performance. The following consequences are also possible:

Anemia (a condition characterized by low levels of hemoglobin, or red blood cells, in the blood). May develop gradually. It occurs due to a lack of vitamin B12, iron, calcium and folic acid in the body.
Dumping syndrome (rapid transfer of poorly digested, concentrated, carbohydrate food into the intestines). In this case, severe dizziness, increased sweating, and palpitations are observed. To eliminate this syndrome, the patient is transferred to split meals (6-8 times a day), with predominantly protein foods.
Dispersion (disturbances in normal functioning gastrointestinal tract– appearance of gases, heaviness, bloating, frequent belching). Sometimes such symptoms indicate an ulcerative relapse, which is eliminated by repeated surgery. In many patients, the dispersion is functional in nature, which does not require surgery and is eliminated by adjusting the diet.
Absorption dysfunction in the body - food passes at high speed and does not have time to mix with the pancreatic secretion and leave useful substances. The reason for this phenomenon may be an increase in bacteria, which is caused by stasis of the efferent loop.
Diarrhea can be caused by dysfunction of fat absorption or lack of lactase.

Advice: to prevent except proper nutrition and giving up heavy physical activity need to keep an eye on psychological state. A positive attitude is one of the main factors for successful rehabilitation. Emotions can be drawn from communication with relatives, friends and neighbors in the hospital ward. Read a book or magazine that interests you, watch a good movie. During the recovery period, do only the things you love.

Restrictions

As a rule, restrictions for patients are temporary. Such people are prohibited from physical therapy and visits to the solarium. Regulate exposure to the sun; heat loads in the form of a sauna or steam bath are also undesirable. Such actions can cause the appearance of metastases.

Women after this operation (especially due to cancer) are not recommended to become pregnant for 3-4 years. Since this is a lot of stress and a number of physiological changes for a woman, they can affect her health and lead to the recurrence of cancer.

Prevention

Basic preventive measure is a strict restriction in food. Eliminate foods from your diet that maximize bile secretion. Since the body cannot carry out its functions sufficiently, chew your food thoroughly.

The main requirements for therapeutic nutrition are:

a sufficient amount of proteins, carbohydrates, vitamins A, B, C;
warm food (neither hot nor cold);
lack of table salt.

Life after gastric surgery can be fulfilling. The main thing is to go through the recovery period correctly. To do this, follow all the requirements and prescriptions of your doctor, follow a diet, and avoid physical activity. Surround yourself with pleasant emotions and a positive attitude, this is the only way you can return to your previous lifestyle.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult your doctor!