Stomach Surgery (Gastrectomy) - Bariatric surgery – Gastric bypass surgery – Weight loss surgery
What is Stomach Surgery (Gastrectomy)?
Gastrectomy is a surgical procedure involving the partial or complete removal of the stomach. It is most commonly performed to treat stomach cancer but is also used for certain benign conditions.
This is a major operation that significantly alters digestive anatomy and function, requiring careful long-term management.
Note: This guide focuses on gastrectomy for medical conditions, not for weight loss (bariatric surgery), which is a separate specialty.
Key Facts About Gastrectomy
- It is a curative procedure for stomach cancer and complex benign diseases.
- The surgery can be performed via open, laparoscopic, or robotic techniques.
- It has profound implications for nutrition, digestion, and quality of life, necessitating lifelong dietary adjustments and vitamin supplementation.
- The procedure often includes removal of lymph nodes for cancer staging and to ensure complete disease removal.
Common Types of Gastrectomy
The type of procedure depends on the disease’s location and extent.
Partial Gastrectomy
- Removal of only the lower portion of the stomach (antrum and pylorus) affected by disease.
- The remaining stomach is reconnected to the small intestine (gastroduodenostomy or gastrojejunostomy).
- Goal: Preserve as much stomach function as possible.
Total Gastrectomy
- Removal of the entire stomach.
- The oesophagus is connected directly to the small intestine (esophagojejunostomy).
- Required for: Cancers in the upper or middle stomach, large tumours, or certain genetic conditions.
- Impact: Requires the most significant long-term dietary and lifestyle changes.
Radical Gastrectomy with Lymph Node Dissection
- For cancer, the procedure includes removing the affected part of the stomach along with the surrounding lymph nodes and fatty tissue.
- This is critical for accurate cancer staging and achieving the best oncological outcome.
Common Issues Treated by Stomach Surgery
Gastrectomy is a solution for several serious conditions affecting the stomach:
- Gastric Cancer (Stomach Cancer): The most common reason for a gastrectomy, aiming to remove the tumour and any local spread.
- Benign Tumours & Polyps: Large growths that cause obstruction, bleeding, or have a high risk of becoming cancerous (e.g., GISTs).
- Complicated Peptic Ulcers: Ulcers that do not heal with medication, cause severe bleeding, perforation, or obstruction.
- Genetic Predisposition: Prophylactic (preventative) total gastrectomy for individuals with high-risk genetic mutations like CDH1 (Hereditary Diffuse Gastric Cancer Syndrome).
When is a Gastrectomy Required?
This major surgery is considered when other treatments are ineffective or not possible. Key indications include:
- Resectable Stomach Cancer: When the cancer is confined and can be completely removed with clear margins.
- Uncontrolled Symptoms: For benign conditions causing life-threatening bleeding, perforation, or obstruction that doesn’t respond to other treatments.
- Prevention: In patients with proven high-genetic risk for stomach cancer (e.g., CDH1 mutation).
- Severe Complications: From previous stomach surgery or chronic disease that has destroyed stomach function.
The decision is made by a multidisciplinary team including surgeons, oncologists, and gastroenterologists.
Risks and Complications
As a major abdominal surgery, gastrectomy carries significant risks:
- Anastomotic Leak: A leak from the new surgical connection is the most serious complication, potentially leading to infection and requiring further surgery.
- Infection: At the incision site or inside the abdomen (abscess).
- Bleeding: During or after surgery, which may require a transfusion.
- Dumping Syndrome: Rapid emptying of food into the small intestine causing nausea, cramping, sweating, and diarrhoea. More common after partial gastrectomy.
- Malnutrition & Weight Loss: Due to reduced food intake and impaired absorption of nutrients (especially Iron, B12, Calcium, and Vitamin D).
- Reflux: Bile reflux into the oesophagus after total gastrectomy.
- General Risks: Blood clots (DVT/PE), pneumonia, and adverse reactions to anaesthesia.
Recovery and Post-Operative Care
Recovery is a phased process, starting in the hospital and continuing at home.
- Hospital Stay: Typically 5-10 days, or longer if a leak or other complication occurs.
- Pain Management: Effectively controlled with IV and then oral medications.
- Dietary Progression (Critical Path):
- Phase 1 (Days 1-3): NPO (nothing by mouth), IV fluids only.
- Phase 2 (Days 3-5+): Clear fluids, then full liquids.
- Phase 3 (Going Home): Pureed and soft foods.
- Phase 4 (Long-Term): Small, frequent meals (6-8 per day), chewing thoroughly. High-protein, low-sugar diet is essential.
- Activity: Walking is encouraged immediately after surgery. No heavy lifting for 6-8 weeks.
Long-Term Follow-Up and Lifestyle Changes
Life after gastrectomy requires permanent adjustments and monitoring.
- Lifelong Nutritional Support: Patients must take daily vitamin and mineral supplements, especially Vitamin B12 (often via injection), Iron, Calcium, and Vitamin D.
- Regular Medical Check-ups: With your surgical and oncology team to monitor recovery and nutritional status.
- Dietician Consultations: Essential for adapting to a new way of eating, preventing deficiencies, and managing dumping syndrome.
- Cancer Surveillance: If performed for cancer, regular CT scans and endoscopies will be needed to check for recurrence.
Frequently Asked Questions (FAQs) About Stomach Surgery
Will I be able to eat normally after surgery?
“Normal” will be redefined. You will need to eat small, frequent meals (6-8 per day) and chew thoroughly. You will likely need to avoid sugary foods and drinks to prevent dumping syndrome.
How much weight will I lose?
Significant weight loss is expected, especially after a total gastrectomy. Working closely with a dietitian is crucial to stabilize your weight and prevent malnutrition.
What is dumping syndrome?
It’s a common side effect where food moves too quickly into the small intestine, causing nausea, cramping, sweating, and diarrhoea. It is managed through strict dietary changes.
Is the surgery done laparoscopically?
Yes, often it is. Laparoscopic or robotic-assisted gastrectomy is common in expert hands, offering smaller scars, less pain, and a faster recovery than open surgery.
How long is the recovery time?
Plan for 6-8 weeks before returning to most normal activities and work. Full recovery and adaptation to your new diet can take several months.
Will I need vitamin supplements forever?
Yes, absolutely. Particularly Vitamin B12, which requires monthly injections or high-dose oral supplements because your stomach (or the part that absorbs it) is gone.
What is the difference between this and gastric bypass for weight loss?
While both remove part of the stomach, gastrectomy for disease removes tissue to eradicate a problem, while bariatric surgery is designed specifically to induce weight loss through malabsorption and restriction.
Can stomach cancer come back after surgery?
Yes, there is a risk of recurrence of stomach cancer, which is why regular follow-up with scans and endoscopies is vital for early detection.
Will I have a large scar?
With open surgery, yes, you will have a vertical abdominal scar. With minimally invasive (laparoscopic/robotic) surgery, you will have several small keyhole scars.
How do I prevent malnutrition?
By strictly following your dietitian’s advice: eating high-protein foods, taking your prescribed supplements without fail, and attending all your follow-up blood tests to check for deficiencies.