CASE ANALYSIS

Topic:

GASTRECTOMY

Gastrectomy is the surgical removal of all or part of the stomach. If only part of the stomach is removed, it is called partial gastrectomy and if the whole stomach is removed, it is called total gastrectomy. This surgery is performed as a treatment for stomach cancer and may also be indicated for a bleeding gastric ulcer, a perforation (hole) in the stomach wall, and noncancerous polyps. The stomach plays a large role in digestion and absorption of nutrients from food eaten. It connects to the esophagus (tube that carries food from the mouth) on one end and the small intestine (primary site of nutrient absorption) on the other end. When part of the stomach is removed, the remaining portion continues its digestive function. If the entire stomach is removed, the esophagus is attached to the small intestine, the digestive process begins in the small intestine, and the body eventually adapts. Dietary changes are necessary for proper nutrient intake. Gastrectomy is also occasionally used in the treatment of severe peptic ulcer disease or its complications. While the vast majority of peptic ulcers (gastric ulcers in the stomach or duodenal ulcers in the duodenum) are managed with medication, partial gastrectomy is sometimes required for patients who have complications. These include patients who do not respond satisfactorily to medical therapy, those who develop a bleeding or perforated ulcer, and those who develop pyloric obstruction, a blockage to the exit from the stomach. The surgical procedure for severe ulcer disease is also called an antrectomy, a limited form of gastrectomy in which the antrum, a portion of the stomach, is removed. For duodenal ulcers, antrectomy may be combined with other surgical procedures that are aimed at reducing the secretion of gastric acid, which is associated with ulcer formation. This additional surgery is commonly a vagotomy, surgery on the vagus nerve that disables the acid-producing portion of the stomach. Removal of the tumor, often with removal of surrounding lymph nodes, is the only curative treatment for various forms of gastric (stomach) cancer. Gastrectomy, either total or subtotal (also called partial), is the treatment of choice for gastric adenocarcinomas, primary gastric lymphomas (originating in the stomach), and the rare leiomyosarcomas (also called gastric sarcomas). Adenocarcinomas are by far the most common form of stomach cancer and are less curable than the relatively uncommon lymphomas, for which gastrectomy offers good odds for survival. The surgery is done while the patient is under general anesthesia. The surgeon makes a large incision from just below the breastbone to the navel. If the lower end of the stomach is diseased, the surgeon places clamps on either end of the area and that portion of the stomach is removed. The upper part of the stomach is then attached to the small intestine. If the upper end of the stomach is diseased, the end of the esophagus and the upper part of the stomach are clamped. The affected portion is removed, and the lower part of the stomach is attached to the esophagus. Diet may present a challenge, especially for those whose entire stomach was removed. Food and liquids now enter the small intestine quickly, causing uncomfortable symptoms that can usually be relieved by eating several small meals and eating more protein and less sugar. Vitamin B12 is absorbed in the stomach and must be supplemented with regular injections by patients who underwent a total gastrectomy. Complications related to the surgical procedure or problems adjusting to an altered digestive tract can occur such as the Dumping syndrome. Occurs when the undigested contents of your stomach are transported or "dumped" into your small intestine too rapidly. Common symptoms include abdominal cramps and nausea.

Reference: Gastrectomy by Stanley J. Swierzewski MD. May 25, 2011. http://www.healthcommunities.com /gastrectomy/overview-surgical-procedure-gastrectomy.shtml