A subtotal Gastrectomy involves the elimination or removal of some parts of the stomach especially those affected with cancer or tumor that include nearby lymph nodes and possibly some parts of other affected organs too. In early-stage disease, subtotal gastrectomy is the choice of treatment for distal-third and middle gastric cancers and tumors, as it provides similar survival rates and better functional outcomes in comparison to total gastrectomy.
Partial gastrectomy, Billroth II
How is the surgery performed?
A subtotal gastrectomy can be performed in different ways depending upon the suitable option. Commonly used techniques involve open surgery or key-hole surgery (laparoscopy). During open surgery, the surgeon makes an incision from the upper mid-region of the abdomen to the naval region to expose the stomach and other internal organs. In patients with cancer, adjacent organs such as the liver and intestines including lymph nodes would be examined to see if cancer has spread. The surgeon will close the arteries in the surgical area attached to stomach. The surgeon will then remove the affected parts of the stomach and after that will rejoin the cut end of the stomach to the ends of the duodenum or small intestine, and close the cut with a few stitches, followed by draining of accumulated fluid. In the case of laparoscopic surgery, the surgeon will make multiple tiny cuts on the abdomen and through one of the cuts will insert a laparoscope that allows the surgeon to view the inside of your abdomen on a screen. Using the images on the screen, the surgeon will then insert the necessary surgical tools through the other cuts and perform the procedure.
- The patients are advised to stop any kind of medications or health supplements around a week before the surgery, especially those which make blood clotting difficult.
- Overnight fasting is required as the surgery is performed on an empty stomach.
- Some blood tests and other diagnostic tests may be advised by the surgeon before the procedure.
- The procedure mostly requires hospitalization for a few days to weeks.
- The surgery is performed under general anesthesia wherein the patient is asleep and the procedure is completely painless.
Post-surgery, a tube is inserted into the nose which helps to keep the stomach empty and is removed once the bowels start working well. An oxygen mask followed by an IV nutrition drip is provided post-surgery to ensure good recovery from anesthesia and vital signs are monitored. Some patients suffer mild discomfort from the surgery which can be controlled with regular pain medications. A special x-ray is performed to assess the recovery. The doctors then decide if you can consume liquid food and progress to solid food. The drains, tubes, catheters, and stitches are further removed in 8-10 days followed by discharge. A follow-up appointment is generally planned in 1-3 weeks post-discharge.
Subtotal gastrectomy involves certain risks such as:
- Blood clots in legs
- Vitamin deficiency leads to complications such as weak bones and muscles, decreased immunity, or anemia.
- Weight loss.
- Incisional hernia.
- Acid reflux, nausea, vomiting, or diarrhea.
- Damage to nearby organs.
- Dumping syndrome occurs when the food is suddenly dumped into the small intestine due to the removal of some parts of the stomach leading to weakness, nausea, dizziness, and cold sweats.
- Narrowing of bowels due to scar tissue formation.
Patients are usually hospitalized for 6 to 10 to ensure timely recovery and lower the risks of complications. Strenuous activities are strictly avoided to ensure a healthy recovery. If the patient experiences symptoms such as high fever, excessive bleeding, vomiting, pain, or any other unusual symptoms, then immediate medical care has to be taken. A dietician may advise to take small frequent and nourishing meals and avoid late-night eating to prevent acid reflux or heartburns. The surgeon may prescribe pain medications for the gradual decrease in pain as the wound heals. Dressings need to be changed when they get wet due to drainage. Bandaging can be stopped and wounds can be left open once the drainage stops. The key to progressive recovery is adequate rest for a few days before resuming back to normal activities.