Gastrectomy





Definition

Gastrectomy is the surgical removal of all or part of the stomach.


Purpose

Gastrectomy is performed most commonly to treat the following conditions:

  • stomach cancer
  • bleeding gastric ulcer
  • perforation of the stomach wall
  • noncancerous polyps

Demographics

Stomach cancer was the most common form of cancer worldwide in the 1970s and early 1980s, and the incidence rates have always shown substantial variation in different countries. Rates are currently highest in Japan and eastern Asia, but other areas of the world have high incidence rates, including Eastern European countries and parts of Latin America. Incidence rates are generally lower in Western Europe and the United States.

Gastrointestinal diseases (including gastric ulcers) affect an estimated 25–30% of the world's population. In the United States, 60 million adults experience gastrointestinal reflux at least once a month, and 25 million adults suffer daily from heartburn, a condition that may evolve into ulcers.


Description

Gastrectomy for cancer

Removal of the tumor, often with removal of the surrounding lymph nodes, is the only curative treatment for various forms of gastric (stomach) cancer. For many patients, this entails removing not only the tumor, but part of the stomach as well. The extent to which lymph nodes should also be removed is a subject of debate, but some studies show additional survival benefits associated with removal of a greater number of lymph nodes.

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 chances of survival.

General anesthesia is used to ensure that the patient does not experience pain and is not conscious during the operation. When the anesthesia has taken hold, a urinary catheter is usually inserted to monitor urine output. A thin nasogastric tube is inserted from the nose down into the stomach. The abdomen is cleansed with an antiseptic solution. The surgeon makes a large incision from just below the breastbone down 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 is excised. 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 together. The diseased part is removed, and the lower part of the stomach is attached to the esophagus.

After gastrectomy, the surgeon may reconstruct the altered portions of the digestive tract so that it may continue to function. Several different surgical techniques are used, but, generally speaking, the surgeon attaches any remaining portion of the stomach to the small intestine.

Gastrectomy for gastric cancer is almost always done using the traditional open surgery technique, which requires a wide incision to open the abdomen. However, some surgeons use a laparoscopic technique that requires only a small incision. The laparoscope is connected to a tiny video camera that projects a picture of the abdominal contents onto a monitor for the surgeon's viewing. The stomach is operated on through this incision.

The potential benefits of laparoscopic surgery include less postoperative pain, decreased hospitalization, and earlier return to normal activities. The use of laparoscopic gastrectomy is limited, however. Only patients with early-stage gastric cancers or those whose surgery is intended only for palliation (pain and symptomatic relief rather than cure) are considered for this minimally invasive technique. It can only be performed by surgeons experienced in this type of surgery.


Gastrectomy for ulcers

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 peptic ulcer 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.


Diagnosis/Preparation

Before undergoing gastrectomy, patients require a variety of such tests as x rays, computed tomography (CT) scans, ultrasonography, or endoscopic biopsies (microscopic examination of tissue) to confirm the diagnosis and localize the tumor or ulcer. Laparoscopy may be done to diagnose a malignancy or to determine the extent of a tumor that is already diagnosed. When a tumor is strongly suspected, laparoscopy is often performed immediately before the surgery to remove the tumor; this method avoids the need to anesthetize the patient twice and sometimes avoids the need for surgery altogether if the tumor found on laparoscopy is deemed inoperable.


Aftercare

After gastrectomy surgery, patients are taken to the recovery unit and vital signs are closely monitored by

To remove a portion of the stomach in a gastrectomy, the surgeon gains access to the stomach via an incision in the abdomen. The ligaments connecting the stomach to the spleen and colon are severed (B). The duodenum is clamped and separated from the bottom of the stomach, or pylorus (C). The end of the duodenum will be stitched closed. The stomach itself is clamped, and the portion to be removed is severed (D). The remaining stomach is attached to the jejunum, another portion of the small intestine (E). (Illustration by GGS Inc.)
To remove a portion of the stomach in a gastrectomy, the surgeon gains access to the stomach via an incision in the abdomen. The ligaments connecting the stomach to the spleen and colon are severed (B). The duodenum is clamped and separated from the bottom of the stomach, or pylorus (C). The end of the duodenum will be stitched closed. The stomach itself is clamped, and the portion to be removed is severed (D). The remaining stomach is attached to the jejunum, another portion of the small intestine (E). (
Illustration by GGS Inc.
)
the nursing staff until the anesthesia wears off. Patients commonly feel pain from the incision, and pain medication is prescribed to provide relief, usually delivered intravenously. Upon waking from anesthesia, patients have an intravenous line, a urinary catheter, and a nasogastric tube in place. They cannot eat or drink immediately following surgery. In some cases, oxygen is delivered through a mask that fits over the mouth and nose. The nasogastric tube is attached to intermittent suction to keep the stomach empty. If the whole stomach has been removed, the tube goes directly to the small intestine and remains in place until bowel function returns, which can take two to three days and is monitored by listening with a stethoscope for bowel sounds. A bowel movement is also a sign of healing. When bowel sounds return, the patient can drink clear liquids. If the liquids are tolerated, the nasogastric tube is removed and the diet is gradually changed from liquids to soft foods, and then to more solid foods. Dietary adjustments may be necessary, as certain foods may now be difficult to digest. Overall, gastrectomy surgery usually requires a recuperation time of several weeks.


Risks

Surgery for peptic ulcer is effective, but it may result in a variety of postoperative complications. Following gastrectomy surgery, as many as 30% of patients have significant symptoms. An operation called highly selective vagotomy is now preferred for ulcer management, and is safer than gastrectomy.

After a gastrectomy, several abnormalities may develop that produce symptoms related to food intake. They happen largely because the stomach, which serves as a food reservoir, has been reduced in its capacity by the surgery. Other surgical procedures that often accompany gastrectomy for ulcer disease can also contribute to later symptoms. These procedures include vagotomy, which lessens acid production and slows stomach emptying; and pyloroplasty , which enlarges the opening between the stomach and small intestine to facilitate emptying of the stomach.

Some patients experience lightheadedness, heart palpitations or racing heart, sweating, and nausea and vomiting after a meal. These may be symptoms of "dumping syndrome," as food is rapidly dumped into the small intestine from the stomach. Dumping syndrome is treated by adjusting the diet and pattern of eating, for example, eating smaller, more frequent meals and limiting liquids.

Patients who have abdominal bloating and pain after eating, frequently followed by nausea and vomiting, may have what is called the "afferent loop syndrome." This is treated by surgical correction. Patients who have early satiety (feeling of fullness after eating), abdominal discomfort, and vomiting may have bile reflux gastritis (also called bilious vomiting), which is also surgically correctable. Many patients also experience weight loss.

Reactive hypoglycemia is a condition that results when blood sugar levels become too high after a meal, stimulating the release of insulin, occurring about two hours after eating. A high-protein diet and smaller meals are advised.

Ulcers recur in a small percentage of patients after surgery for peptic ulcer, usually in the first few years. Further surgery is usually necessary.

Vitamin and mineral supplementation is necessary after gastrectomy to correct certain deficiencies, especially vitamin B 12 , iron, and folate. Vitamin D and calcium are also needed to prevent and treat the bone problems that often occur. These include softening and bending of the bones, which can produce pain and osteoporosis, a loss of bone mass. According to one study, the risk for spinal fractures may be as high as 50% after gastrectomy.


Normal results

Overall survival after gastrectomy for gastric cancer varies greatly by the stage of disease at the time of surgery. For early gastric cancer, the five-year survival rate is as high as 80–90%; for late-stage disease, the prognosis is bad. For gastric adenocarcinomas that are amenable to gastrectomy, the five-year survival rate is 10–30%, depending on the location of the tumor. The prognosis for patients with gastric lymphoma is better, with five-year survival rates reported at 40–60%.

Most studies have shown that patients can have an acceptable quality of life after gastrectomy for a potentially curable gastric cancer. Many patients will maintain a healthy appetite and eat a normal diet. Others may lose weight and not enjoy meals as much. Some studies show that patients who have total gastrectomies have more disease-related or treatment-related symptoms after surgery and poorer physical function than patients who have subtotal gastrectomies. There does not appear to be much difference, however, in emotional status or social activity level between patients who have undergone total versus subtotal gastrectomies.


Morbidity and mortality rates

Depending on the extent of surgery, the risk for postoperative death after gastrectomy for gastric cancer has been reported as 1–3% and the risk of non-fatal complications as 9–18%. Overall, gastric cancer incidence and mortality rates have been declining for several decades in most areas of the world.


Resources

BOOKS

"Disorders of the Stomach and Duodenum." In The Merck Manual. Whitehouse Station, NJ: Merck & Co., Inc., 1992.

"Stomach and Duodenum: Complications of Surgery for Peptic Ulcer Disease." In Sleisenger & Fordtran's Gastrointestinal and Liver Disease, edited by Mark Feldman et al. Philadelphia: W. B. Saunders Co., 1998.

PERIODICALS

Fujiwara, M., et al. "Laparoscopy-Assisted Distal Gastrectomy with Systemic Lymph Node Dissection for Early Gastric Carcinoma: A Review of 43 Cases." Journal of the American College of Surgeons 196 (January 2003): 75–81.

Iseki, J., et al. "Feasibility of Central Gastrectomy for Gastric Cancer." Surgery 133 (January 2003): 75–81.

Kim, Y. W., H. S. Han, and G. D. Fleischer. "Hand-Assisted Laparoscopic Total Gastrectomy." Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 13 (February 2003): 26–30.

Kono, K., et al. "Improved Quality of Life with Jejunal Pouch Reconstruction after Total Gastrectomy." American Journal of Surgery 185 (February 2003): 150–154.


ORGANIZATIONS

American College of Gastroenterology. 4900-B South 31st St., Arlington, VA 22206. (703) 820-7400. http://www.acg.gi.org .

American Gastroenterological Association (AGA). 4930 Del Ray Avenue, Bethesda, MD 20814. (301) 654-2055. http://www.gastro.org .


OTHER

Mayo Clinic Online: Gastrectomy. http://www.mayohealth.com .


Caroline A. Helwick
Monique Laberge, PhD

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


A gastrectomy is performed by a surgeon trained in gastroenterology, the branch of medicine that deals with the diseases of the digestive tract. An anesthesiologist is responsible for administering anesthesia, and the operation is performed in a hospital setting.

QUESTIONS TO ASK THE DOCTOR


  • What happens on the day of surgery?
  • What type of anesthesia will be used?
  • How long will it take to recover from the surgery?
  • When can I expect to return to work and/or resume normal activities?
  • What are the risks associated with a gastrectomy?
  • How many gastrectomies do you perform in a year?
  • Will there be a scar?


User Contributions:

wonda ronck
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Feb 10, 2006 @ 2:14 pm
a friend has had his esophagus and upper stomach removed,now within a few months he has to have his whole stomach removed. with no esophagus to attach any thing to, what will happen. i have tried to find this information to no avail. the patient is only 43 years old.
how can he survive and what type of life can he exspect.
barbara
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Mar 5, 2006 @ 1:13 pm
my question is: after subtotal removal of the stomach what if any affect does drinking alcohol have? My husband had this operation 6 months agao and continues to drink 6-8 cans of beer oer day....thank you
Holly
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May 9, 2006 @ 10:22 pm
My father had a total gastrectomy in Dec. He has had severe burning and pain in his chest and back since. Also has had cronic asperation pneumonia. Has anyone heard of this or know what is happening?
Charla Eason
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Jul 19, 2007 @ 6:18 pm
My husband had a gastrectomy, including several inches of the small intestine, 2/18/04 and has done very well. He also has esophogus spasms, causing difficulty eating. He appears to have aged significantly since the surgery, and I am very concerned about his nutrition. We were told he could absorb only about 20% of the food he ate, but with the spasms he looses a lot of that. I feel he needs more nutritional supplementation, but am unsure as to what type supplements can be absorbed efficiently.

Your help will be greatly appreciated.
fazil
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Mar 22, 2008 @ 3:03 am
My cousine had a total gastrectomy two monthes ago. He has had severe burning and pain in his chest and back since. We were told he could absorb only about 20% of the food he ate, but with the spasms he looses a lot of that. I feel he needs more nutritional supplementation, but am unsure as to what type supplements can be absorbed efficiently.
Your help will be greatly appreciated.
Maria
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Apr 16, 2009 @ 1:13 pm
My Dad who is 67 was diagnosed with stomach cancer. They removed part of the tumour last march 16th,2009 but still have some since it was so attached that they decided it was riskier to take it off than leave it, but the cancer has spread to the aorta and my family (5 brothers and sisters,myself and my mom are worried and we are lost we don't know what can we do to help him battle against this disease.

the medical report was:

A gastric carcinoma, already metastasized to the extra-perigastric lymph node. Studies showed a small depressed lesion on the lesser curvature of the antrum and histology of the biopsied specimen revealed a well differentiated adenocarcinoma. Under the diagnosis of IIIc type intramucosal carcinoma, partial gastrectomy and wide lymph node dissection was performed. Pathologic study of the resected specimen showed that the cancer cells had invaded the submucosa at an area via a lymphatic vessel and that only lymph node along the common hepatic artery was involved.

if somebody can help me i will appreciate it.
E shields
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Dec 8, 2009 @ 5:05 am
Excellent article ,all aspects very clearly explained ,would recommend for any patient undergoing this procedure
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Dec 4, 2010 @ 3:15 pm
I had half my stomach removed due to ulcers; now I have lost 10 pounds and its 3 months later. I also have a constant stabbing pain on left side and bad stomach pain after eating. Whats my prognosis? I am down to n80 pounds and I am 5.6 height 59 years old
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Dec 28, 2010 @ 10:22 pm
7 years ago my beautiful sister had a total gastericectomy she had a lot of the complications you describe and so much more. Before the surgery she was a rare drinker (glass of wine occasionally) after, that glass increased to a bottle a night with-in 1yr., that progressed to vodka and lastly gin. She became a full blown alcoholic and she lost 180lbs. We lost her 11/29/2010 I do not wish anyone to suffer the poor quality of life she had this seven years. To the person who posted concerns about her fathers drinking fight for him beg him do what ever you have to to get him help. I will pray for all of you may God keep you all safe. I love you Sis'.
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Jan 11, 2011 @ 4:04 am
My father recetly passed away due to aspiration pneumonia. His gag reflex failed. He had 80% of his stomach removed in the 70s. Could the lack of stomach accellerated his death? (His doctor said that even with a stomach tube tube, he would eventually pass in a non-specific period of time due to the complications associated with the lack of reflex and that a stomach tube would be of minimal value).
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Jan 23, 2011 @ 12:00 am
My husband had a partial gastrectomy on the 31st December 2010. The surgeon left 20% of the stomach behind and removed 80% where the tumour was. My husband is now feeling well and is starting to eat more and more. Is this the end of his cancer? Will he now live a LONG normal life?

Regards
Helen
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Feb 12, 2011 @ 12:00 am
I had a partial gastrectomy a couple of years back. I lost a total of 10 pounds from the surgery. Now I am consuming a normal diet and living a happy and healthy life. Life is great for me. Complication are very minor, only some stabling pain to the my left side of my stomach when I overeat, which I think is a good reminder to me that I am full. =)
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Feb 27, 2011 @ 6:06 am
hi, i study medicine and was wondering about this question:-

in a pt. with a fully removed stomach, what do u expect this pt. will develop regarding his/her RBC count? and when after the operation?

and how do u treat him and why ?


thanks.
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Mar 2, 2011 @ 5:17 pm
I am a 44yr old female in Oct. 2010 had a total Gastrectomy with reconstruction.Life is a total change and reconstruction.I was diagnosised with Mentrier diseases and the was the way to remove the disease.They predicted I could weigh as little as 90 pounds and I'm 5'8.I'm at 130 now and I fight,pray,and try to stay as close to God as possible.There is not alot of information about diet or how to cope that i have found.The town where I live had never seen or preformed this type of surgery.A thing called "Dumping Syndrome" is the biggest challenge.Your stomache is a storage tank and w/o one you can't store fat,protien,B12 or anything.You can only consume about 1 cup of food at a meal so it is a daily fight to keep protien up and vitamins in your body because they do not asorb like they did.I can't tolerate any milk based products,so I have a protien powder I mix with coffee.This has been relaay hard for me and my children,I was very healthy with no medical issues,I thought I had a virus and if I had not become short of breath I probably would of never went the the ER that night.My will power now and being in good health before is why I survived.The will power is the key.You have to decide each morning when you wake up that Today I'm gonna fight for myself,or it will consume you.
lisa
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Mar 19, 2011 @ 9:21 pm
My friend has had two surgeries that took parts of her stomach out . she has a quarter left. They keep finding multiple ulcers. So this is why this has been done .Now she just had an operation to deal with hernias that developed after her her second stomach removal surgery. They had to rush her in and she had a two hour surgery that has left her cut open even more. They found multiple ulcers again and need to open her up and take more of her stomach. What is going on. The docter doesn't know why. I pay someones comes up with something over looked. Thanks Lisa
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Apr 4, 2011 @ 8:20 pm
Good info - I'd like to share this with someone that I know is having stomach surgery(most likely complete removal) in a few days
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Apr 4, 2011 @ 10:22 pm
I am having surgery in 2 days and am having 2nd tho'ts about actually having the surgery and what quality of life would be after surgery. The testimonials that I read after your info presentation are not favorable at all- why would someone risk all this unpleasantness to have 5 more years of life that has a high percentage of being rotten, depressing, and malnutritioning ? Seems you die from malnutrition in the end!? Even if you do live, what pleasure is there in having to eat 8 times a day, one cup at a time(or even less) and then having discomfort almost constantly? It's enough to drive one to drink just to get thro' this. I haven't come across anyone who can honestly say that life is better, or as good as or even tolerable after having this surgery!
Sometimes, leaving well enough alone is the answer. In my case, if I hadn't had a spell of vomiting blood, no one would have known about the cancer. I may survive 15 years going along like I have been and having a relatively good life. Why does western medicine feel they have "to cut stuff out" as the first solution. There are reasons that this happened in the first place(lifestyle and incorrect eating/drinking are foremost) but can't this stuff be treated otherwise with root cause solutions? I am having less & less faith in our North American doctors and their way of treatment - they mostly are closed minded to to other forms of treatment and do not acknowledge or work with other trained practitioners, not only in this situation but with other minor day-to-day problems. I think that the Pharmaceutical companies have them roped -all due to making money and the patients are at their mercy. If there is a cure, nobody can sell drugs and then nobody makes any money!My current situation is making me crazy and anxious(not a good way to go into surgery) and also depressed - like there is no hope. Please give me something to hang onto that is positive and encouraging.
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Apr 16, 2011 @ 11:23 pm
I had my entire stomach removed along with an ulcer in 2009 that was attached to it because of too much acid in the stomach. All this happened after Gastric By-Pass Surgery in 2006. I am having pain once again in the stomach area and it feels exactly like the ulcer has returned. I'd like to know if it is possible to have an ulcer returned after it has been removed through surgery?
Michelle P
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Jun 4, 2011 @ 5:05 am
Hi I'm a 39 female who was diagnosed with a stomach tumor in March this year. I have just finished 3 cycles of chemo and will have another scan on Monday to see what extent the surgery will be in the coming weeks. I am an unlikely statistic for this type of cancer considering my age and I really would like to hear from people who have gone past the 5 year statistic and have some positive things to say about a gastrectomy. I am definitely heading down that path but my oncologist said that this is very curable, which gives me hope. I have too much to live for, for this cancer to beat me and I am sure there are others out there who feel the same.
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Jun 23, 2011 @ 12:12 pm
This to Phyllis Snook. Sorry to hear of your problems after gastric resection. You might check with a gastroenterologist to have an endoscopy to see the problem. perhaps a barium swallow and or an upper gi as a second option. Are you related to Theodore Snook a wonderful professor of histology at the University of North Dakota School of Medicine in the 50's and 60's? He was one of the greatest medical teachers that ever lived.

John
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Sep 10, 2011 @ 5:17 pm
HELLO THIS IS A CLINICAL CASE I AM STUDENT OF MEDICINE FIRST YEAR
DEN ME AND I WANT YOUR OPINION ON THIS.

AN INDIVIDUAL 50 YEARS THAT pale, underweight, say they have undergone a surgery in which he had lost part of the stomach and the chief cells. he ordered laboratory tests which report the following resultados.hemoglobina low colipase activity greatly diminished, parietal cell atrophy.

questions
to be low weight?
as is the digestion and absorption of lipids Why?
protein digestion and intestinal gastric level and is why?

I hope your answer and sorry for the inconvenience

COLOMBIA,BARRANQUILLA
AprilAlexios
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Sep 21, 2011 @ 10:10 am
I am a 36 year old female who had gastric bypass open roux-en-y in 2003. About 6 months after the surgery I was in the hospital for the first of many times. I suffered through many procedures to try and stop the chronic ulers I had. There was just to much acid. I threw up everything (yes even bland small amounts of food). After one endoscopy the gastro Doctor said it was like he hit something hard. Well(I have never heard of this) the bariatric Doctor who perfomed my surgery had put a metal ring around the top of the stomach and this ring had preforated sideways into my stomach. In 2007 after being admitted to the hospital for vomitting blood and being so anemic and dehydrated the Doctors said they had to go in and try to repair my stomach. I woke up with a ng tube sutured into my nose, a feeding peg in my abdomen and 4 drain tubes. There was just nothing to save they said and had preformed a total gastrectomy. I spent a total of 5 weeks in the hospital, some of that in icu because the medications almost overdosed me.
In many ways things eventually (like 2 years) improved. It took about four months to get them to take the feeding peg out. My weight went down to 85 pounds. In December 2008 my doctors worst nightmare happened, I found out I was pregnant(this was so not planned). They told me that I couldn't carry a pregnancy. I felt I had to try and after hearing a heart beat on my husbands birthday on christmas eve, I knew I had to. The strangest thing is that I was so healthy during my pregnancy. I had the best medical care and the insurance company who had been previously denying to pay any claims had to cover me while pregnant. I had iron infusions which I had never heard of. My specialist said that a womans digestive system slows during pregnancy so I was finally aborbing nutrients and taking lots of vitamins. I carried her to 38weeks and was induced giving birth to a perfect healthy little girl who just turned two. She is my miracle and makes me laugh every day even when some of those days are not so good.
Unfortunately the reactive hypoglycemia has returned and I have to be very careful or I will have seizures. I have just recently been hospitalized with abdominal pain following a bout of vomittin, I still have dumping syndrome. I was transfered from the hospital I was in to the Cleveland Clinic where I stayed for another week. I had a pic line and 24 TPM. Didn't really get clear answers aside from I have alot of lesions, adhesions and scar tissue. I am home now yet barely able to eat without vomitting which really hurts. I have followup with one of the cleveland Doctors soon and hope to have answers but feel another nightmare is just beginning. Trying to stay positive.
Muscles
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Nov 6, 2011 @ 12:00 am
To Mr. Robert Jones above:(And anyone else who wants to listen),

I too am leading up to a total Gastectomy. I have had all of the feelings that you have described to the letter.

A year ago I was 220 lbs of rock solid weight lifting linebacker. Now I'm 179 lbs and dropping with my wardrobe all but swapped out for mediums.

After 6 months of avoiding the warning signs of pain after eating and a doctors warning that I had stomach cancer, I tried a natural route for 5 weeks of carrot juice and a special diet.
But with my stomach swelling almost to the point of covering my Pyloris on my last Endiscopy, The Homeopathic Christian that sold me on the diet tells me that it has to swell before it gets better. Well, I can't take the chance any longer.

I'm undergoing the last of my blood & barium scans etc and then I will probably get my self gutted like a fish. And I am on board with you that why would I ever want to do this to myself and subject myself to all of the above pain and suffering.

I can barely eat now without pain so whats have I got to lose. My other reason to live is a my son. If not for him and my wife, I'd go as far as I could and pull the trigger on my 9.

Pretty sure life is gonna suck if I do this but if I'm lucky I can meditate my way through it. If not, There's always a round in the chamber.

Life's not fair sometimes and these are the cards I've been dealt. I didn't care so much when I was swilling a 5th of Jim Beam a night and eating a steak at 2 in the morning. Life was good.

At 49 I often reflect back on what my father always said, If I only knew then what I know now.

Good luck to all.
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Nov 12, 2011 @ 10:10 am
Very intersting information, as well as valid comments from all who are in this situation. I was diagnosed with adenocarcinoma of the stomach about 3 months ago. It was suggested that I immediately go for a partial gastrectomy, but I could not accept that. I have followed alternate therapies, hoping that I could 'escape' the allopathic route as I was always so against it. But with much deliberation and perhaps exploring causal factors into my situation has now switched my feelings about this - that sometimes medicine has to be combined with homeopathic and alternative medicines to allow healing to happen. Support from my homeopath has also helped me tremendously so that I could look within myself and make a CHOICE.
It is still a very scary thought as my surgery will be in about 2-3 weeks time, and i have never had surgery before. When I read about the post-op adjustments that have to be made, it seems too much to bear. But the decision came from within me - trusting ones intuition will always lead to the correct action. And I am now wanting to go on with my life without this hanging over my head.

For all who have been through this, thank you for sharing your stories - they are so valuable to people like me. To those who are still going to have their 'adventure', may everything go perfectly well.
Praying that we are ALL healthy and HAPPY!
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Nov 20, 2011 @ 9:21 pm
Hello to all of you who have made comments and I acknowledge the difficulty some of you are having. I had a total gastrectomy nearly 2 years ago (I was 58) for adinocarcenoma. Yes, eating can be an issue but I have become very rigorous with all my eating and drinking; this has really helped me maintain a very good quality of life. The most important tips are:

1. Do not drink after eating for at least 1/2 an hour and wait 1/2 hour after drinking before eating.
2. Stay away from fatty foods, highly refined foods (eg cake and white bread, high carbs) and food with lots of sugar.
3. Yes, eating lots of small meals a day is frustrating but I cope now as single mum of a teenager and working fulltime. The day I was able to eat 2 whole poached eggs was a celebration!!
4. When eating, do it slowly and chew everything very well.
5. Do not expect to much from yourself. Losing your stomach and adapting is a huge learning curve.
6. Gastric dumping is awful and can be very debilitating. There are varying degrees of gastric dumping - mild (feeling tired) to severe with dizziness, severe vomiting, awful stomach cramping and diahorrea.
7. I have found that one of the best ways reduce the effect of dumping is to lay down - this slows the process of the food passing through your intestines. Dumping is basically the body working to get rid of the food quickly and it can happen just after a meal or a few hours later. For me its usually because I have eaten a bit to much or had something I should not have. Remember that one extra mouthful can push you over the edge. It takes time to know how much you can tolerate in a meal. See the wikipedia site for more information on gastric dumping syndrome.

Because this only lets me put in a maximum of 4000 characters I will do this in 2 parts - see more below.
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Nov 20, 2011 @ 9:21 pm
8. One of the most difficult things I have found is aspiration gastroesophageal reflux. Basically, this is inhaling your reflux and tends to happen at night. With a total gastrectomy I no longer have the valve at the base of the oesophagus to stop food etc coming up. Its scary, waking to find it difficult to breath - the first time it happened I thought I was having a major asthma attack. To deal with this I now sleep with a number of pillows - three and one in front of them to form a sort of a ramp. Another solutions is to raise the head of your bed but it would have to be fairly high, maybe 8 inches. And being a typical female I don't want to spoil the look of my bed.
9. See your dietician regularly, the information they have is invaluable. I see mine every 3 months now, mainly just to monitor my weight.
10. Vitamin supplements are now essential for me. Daily I take a multi vitamin and iron tablet. Every three months I have a B12 injection (by the time 3 months is up I know I need it).
11. Stay positive, say I am not going to let this beat me, ok that food did not suit me what else can I try now. Look for solutions and I know, some days its hard to be positive.
12. I now cook a number of casserole or stew type meals with lots of different vegetables and often throw in a handful of chick peas or lentils. This softens all the foods - it is difficult to impossible for the duodenal to absorb nutrients from some raw vegetables.
13. One of my favourite meals is made in muffin tins. I line them with puff pastry and fill with pre cooked minced pork & veal, lots of chopped vegetables, one egg to bind it, sweet chilli sauce and tomato sauce. Cook them for about 25 mins in the oven. Two of these are a great meal, taste great and are good for me. Generally I make about 24 and this only takes a few sheets of puff pastry. I cut each sheet into 9 pieces and they fit nicely into the muffin tin.
14. Have lots of different meals in the freezer, its just so handy to pull something nice out.
15. My food of a day is usually; Porridge with milk (buy one of those nice flavoured ones but not with to much sugar), cup of tea, wedge of brie cheese, cup of coffee, banana, cup of tea, lunch (usually one of my frozen meals - stew etc), glass of water, apple (chew this very well), cup of tea, dinner (I make the meal as I would have done pre surgery and freeze the remainder), yoghurt and then warm milk before going to bed.
16. I find that I cannot drink or eat anything that is icy cold. Plus, if I have too much in the way of milk products the new stomach system lets me know its uncomfortable.

GOOD LUCK ALL.
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Mar 28, 2012 @ 1:01 am
Dear ser/madam

my husbud was suffering from a serious gastric ulcer, his Doctor has remover the part which was bleeding just befor a month but till now he didn't get any relief, and also I need ur recomendation as what are the diet given to him after this operation. thank you
shereen
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Apr 24, 2012 @ 5:05 am
My dad is 82 years old and had total gastrectomy in November 2011. He is underweight and finds it is very difficult for him to increase weight. Currently, he is recuperating slowly and after every meal he vomits out jelly like flamm. Is this stomach acid?

Anybody can suggest some diet for him to increase weight? My dad is taking vitamins supplements such as folic acid, ferrous for his blood, zinc, vit B, Vit B-12 injection once a month and vit C also.

Kindly advise me...
Aisha
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May 11, 2012 @ 3:15 pm
My father is 58 years old and he was diagnosed with stomach cancer in march 2011,about 75percent of his stomach got removed and went for chemotherapy four times,.it started again some discomforts and the Doctors kept telling him it's dumping syndrome...he lost so much weight and looked so old,after he was diagnosed That he has colon cancer and went for another surgery then chemotherapy which resulted to obstruction and was on drip for 3 wks and he is just loosing weight each day by.he is now on d 2nd chemotherapy ch is also 4 times. I'm worried about his nutritional supplement.pls I need your help on how often he should eat and what
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Jun 14, 2012 @ 12:00 am
As a result of hypertrophis gastric mucosa (Menetriere's syndrome) and a football sized benign tumor in my duodenum, I was given a total gastrectomy and double partial jejeunectomy (sp?). I find, years later, that I can eat almost anything but my problem now is that time-release medicines seem to work badly since they are completely through the GI tract before the pain meds work. As I am now developing arthritis, the finding of adequate pain relief is difficult when dealing with pain clinics who are used to a full adsorption in the stomach and duodenum. Any thoughts?
Paula Hogan
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Aug 21, 2012 @ 6:06 am
my 76yr old mother was diagnosed with stomach cancer in may 2010 she was told it was caught early and that the complete removal of her stomach, as the cancer had not spread would do the trick they warned us about the dangers of the operation but didn't tell us half, after the surgery she went into intensive care and was extremely ill so ill in fact they put her on life support she blew up like a ballon and looked nothing like my mother, after about 4 weeks on that she had a trachea fitted after another 4 weeks the trachea was removed and she went to a normal ward, she obviously hadn't eaten all this time and when she tried to eat she just vomitted it back up and all through the day she vomitted a foamy like substance, she lost 4 stone in weight they sent her home but she couldn't get out of bed or eat or do anything she went back and forth to hospital but they did nothing to end this just passed her from piller to post, her hair fell out she aged 20years and after suffering for 10 months she finally gave up and died in the same intensive care bed she starting in 10months earlier, we were told after that she had leaks in the join of her surgery and this was poisoning her, she died a very slow and painful death and if i could meet the surgeon who messed up her operation i would gladly take his stomach out and make him suffer like my mother suffered. this has to be the most painful thing anyone can go through to watch a loved one suffer so, my mother was a very strong woman and was reduced to a pityful old lady by this man, i will never forgive or forget.
julie
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Oct 26, 2012 @ 2:02 am
In dec of 2009 i had a lap nissen surgery completed due to severe acid reflux, about 6 months later i started having chest pains and vomitting (which was not suppose to happen) anf followed up with my surgeon who advised me that there was nothing he could do and i had to live with the pain, he did no work-ups to see what was wrong. Severalmonths later the pain was unbearable and i called my surgeon once again to only find out he had moved out of the state. I then followed up with my family dr who referred me to another surgeon. The surgeon did a complete work-up and found that my stomach had moved into my chest and 83% of the food i was eating was staying in it in turn was crushing all of my other organs. This surgeon advised me that there were several other patients that were having the same difficulties due to how the first surgeon sewed our diaphrams back into place. He then referred me to a specialist who had to redo the lap nissen surgery snd perform a procedure called a pyloroplasty which opens the valve in the stomach to release the excess food that was staying in there. This resulting in constant diareha. A year later i started having severe heart burn again and severe chest pains that were the worst i have ever had along with a loss of appetite. After several more work-ups i found that my stomach had moved again. I was advised that they would be removing part of my stomach to lenghen the esophogus so the acid had farther to travel. 6 weeks ago i went in for the surgery and woke up having to have a complete gastrectomy. My stomach was completely twisted and no longer even functioning and the only option was to remove it. I ask myself daily what if i had listened to to first surgeons advise and just live with it, where would i be today? I am very thankful for pursuing another dr and getting taken care of. Now after having my whole stomach removed i am having alot of trouble trying to find answers as fat as what i can and cant eat. What will happen if i drink alcohol, which i only do once a year but it would be nice to know whatto expect. I have read that many people end up not even being able to return to work. I am a 40 year old mother and not being able to work and provide for my childeren scares me the most. I am a very determined person and know i can do this but just need help finding answers to questions i have, i try to get some online but never really get anything and i figured the next best thing is to ask others who have been throughthe same surgery. I must commend all of you on your acvomplishments through your journey with all of this, i know it is not easy thats for sure. Thank you for your time in reading this and for sharing your stories. Please if you can guide me in any directions that may be helpful i would greatly appreciate it.
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Feb 18, 2013 @ 11:11 am
I am a 78 year old male recovering from a total gastrectomy performed on Jan. 16th, 2013. I am home now trying to recuperate.
I am eating solid foods, yes in small quantities, several times a day, and tolerating it well. I have not experienced dumping syndrome. My only problem now is that I have contacted pneumonia, a condition though treatable and curable has left me very discouraged. This gastrectomy was my second procedure for gastric cancer. I had a partial gastrectomy in 2007 for gastric cancer. At that time I was told that all surrounding areas were cancer free. This year I was told the same, that all surrounding lymphnodes were clear. As I said, very discouraging.
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Apr 17, 2013 @ 12:12 pm
I am 44 and had a complete gastromectoey on 1/8/13 due to severe ulcers after gastric bypass on 4/23/10. I experience dumping syndrome every time I sat. I eat small meals, high protein, low carbs, low sugar and gluten free. I am not doing well and hoping to connect with other who have experienced the same as I. Thanks
francisco paulo da fonseca
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Jul 19, 2013 @ 6:06 am
Who is the best way to treat medical complications after radical gastrerectomy, like anemia, osteoporosis and lythiasis?
How to meassure these complications accurately?
Thank you.

Dr. Francisco Fonseca
BLANCHE
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Sep 18, 2013 @ 7:19 pm
I HAD HALF MY STOMACH REMOVED TWO YEARS AGO DUE TO STOMACHE ULCER,IVE LOST TWENTY FIVE POUNDS AND CAN NOT GAIN WEIGHT IM DOWN TO 104,IVE HAD IRON INFUSIONS FOR ANEMIA THEY HAVEN,T HELPED UNABLE TO PUT WEIGHT BACK ON.FOOD TAKES FOREVER TO LEAVE STOMACH.

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