The stomach is an organ in the digestive system located between the esophagus and the small intestine. Its primary function is to mechanically and chemically break down food, store it, and pass it in controlled portions to the small intestine for absorption.
Gastrectomy is a surgical procedure performed mainly to address stomach growths, polyps that are not amenable to endoscopic removal, or severe gastrointestinal bleeding that cannot be treated by other means. The surgery may involve complete removal of the stomach and surrounding lymph nodes or partial removal, depending on the surgical indication.
Before the gastrectomy, the patient will be required to undergo blood tests, chest X-rays, electrocardiogram (ECG), and other necessary examinations. They will need to provide medical clearance from their attending physician and additional approvals from specialists concerning any underlying medical conditions.
All documents and test results should be brought on the preoperative visit to the outpatient clinic.
During the preoperative visit, the patient should report the use of blood-thinning medications such as aspirin, Plavix, or Coumadin. In some cases, discontinuing these medications may be required before the surgery. However, this should only be done under explicit medical guidance.
After the outpatient clinic evaluation process, the patient will be scheduled for surgery.
The surgery is performed under general anesthesia and typically lasts for 3-5 hours. During the procedure, the patient will be connected to tubes and devices, including a feeding tube and drains for fluid drainage. These tubes and devices will be gradually removed as the patient recovers.
Upon completion of the surgery, the patient will be moved to the recovery unit for several hours while the surgeon updates the family on the surgery's outcome. Afterward, the patient will be transferred to the surgical department for further treatment.
In the surgical department, the patient will receive pain management through an epidural or intravenous medication pump. Nurses will administer these medications at regular intervals, and additional pain relief can be requested up to a certain limit.
Early after the surgery, respiratory physiotherapy is essential. This is initially performed with the help of a physiotherapist but later can be done independently using a dedicated device that encourages deep breathing exercises. This is crucial as the lungs may be partially contracted following general anesthesia, and helping them expand prevents fever and potential lung inflammation.
It's essential to get out of bed and move around to prevent blood clots, aid in restoring gastrointestinal function after surgery, and reduce complications.
The length of hospitalization typically ranges from one to two weeks, depending on the absence of complications.
After gastrectomy, the digestive system needs to adapt to the new condition, where food goes directly to the small intestine. During the hospital stay, the patient will receive nutritional counseling regarding food types and eating patterns.
A common complication after the surgery is dumping syndrome, which occurs after consuming meals high in sugar. Symptoms may include weakness, sweating, palpitations, and pallor due to rapid movement of food to the small intestine and a drop in blood sugar levels. To prevent this, the patient should eat small meals and reduce sugar intake.
Possible complications during or after the surgery include bleeding, infection, leakage of intestinal content, and the formation of a hernia in the surgical site.
Upon discharge from the hospital, the patient should seek medical attention if any of the following symptoms occur:
- High fever above 38.5°C or chills
- Redness, swelling, worsening pain, or any discharge from the surgical area
- Uncontrollable nausea or vomiting despite medications
- Unmanageable pain even with painkillers