Different diseases can make gastric surgery necessary. Depending on the disease, different procedures are undertaken. Several procedures will be explained in more detail below: Stomach removal (gastrectomy, stomach resection), pyloric orifice enhancement (gastroenterostomy) and percutaneous gastric tube (gastrostomy).
Gastric operations can be required for various reasons. The main reason for a partial or complete stomach removal is stomach cancer. Operations on benign stomach ulcers are only required in patients with complications such as perforation of the stomach or haemorrhaging. The rest of the stomach must then often be connected with the small intestine in patients undergoing gastric surgery. This procedure is called gastroenterostomy. In the case of constrictions of the pylorus due to tumours or scar tissue, the pylorus is surgically expanded. In the event of diseases of the oesophagus or the stomach entrance, sometimes a stomach food tube needs to be laid through the abdominal wall (gastonomy).
Surgeries such as gastric bypass or stomach band undertaken on obese patients will be described in the chapter entitled Bariatric surgery. Surgical treatment in patients with reflux of gastric juices into the oesophagus is explained in the chapter entitled reflux operations.
What preparations are carried out before the procedure?
Depending on the disease of the stomach, different examinations are used. A gastrostomy is one of the most common ultrasound methods in patients with gastric diseases. Ultrasound, computer tomography and contrast agent x-rays are further possible examination methods before a gastric operation.
All blood-thinning medication must be discontinued before the procedure takes place. Gastric surgery is performed under general anaesthetic. Patients should therefore be fasting for the procedure.
How is the operation performed?
The choice of operation method depends on the individual patient situation and the type of disease. Where possible, the procedure is performed laporoscopically, i.e., minimal invasively without opening the abdominal wall.
In a gastrostomy, an artificial mouth of the stomach is laid through the abdominal wall. In the process, a pipe is laid through the skin and the abdominal wall into the stomach. This tube serves as a feeding tube if a gastric tube is not possible through the nose.
Stomach removal, gastrectomy, abdominal resection
The main reason for stomach removal is stomach cancer. Depending on the stage and the extent of the cancer, a partial or a complete stomach removal is undertaken. Today, stomach removal can be undertaken laporoscopically. The camera and surgical instruments are initially inserted via several incisions in the abdominal wall. The stomach or the parts affected by a tumour and then detached and removed. Sometimes an artificial connection between the rest of the stomach and the small intestine is required (gastroesterostomy). If the entire stomach is removed, the upper section of the duodenum will then serve as a replacement stomach.
A gastroenterostomy can often be performed laporoscopically. During a gastroenterostomy, the stomach is connected directly to the small intestine (jejunum). The pyloric orifice and the duodenum are bridged in the process.
Pyloric orifice enhancement, pyloroplasty
The pylorific orifice enhancement or pyloroplasty is used in the event of constrictions of the pylorific orifice. Tumours, stenoses or scar build-up can be the cause of the constriction.
Pyroplasty is usually performed laporoscopically. As in the case of other stomach operations, the instruments are first introduced through incisions in the abdominal wall. If tumours or cancers are responsible for the constriction, a pyloroplasty is usually combined with other operations. Pyloroplasty is only used as a result of inflammations during benign constrictions.
What is the success rate of this procedure?
The prognosis after gastric surgery depends on the type of disease. In the event of cancers, the prognosis is generally good if the tumour can be completely removed and there are no metastases.
What are the possible complications and risks of this procedure?
Stomach operations are standard procedures. Depending on the type of underlying disease and the surgical methods used, different complications can occur. Sometimes, it can result in nerve damage, haemorrhaging or infections. Artificial connections with the small intestine can sometimes function inadequately.
What happens after the operation?
After the gastric operation, a gastric tube is often required for several days. Food build-up takes place slowly and gently. The body must be accustomed to the changed conditions in the digestive tract. At the beginning, upper abdominal complaints such as a feeling of fullness or nausea. Due to the missing stomach, the food often reaches the small intestine too quickly. This can lead to an increase in blood sugar or diarrhoea. The patient's eating behaviour should be adjusted to these changed conditions. Only small individual portions and this several times per day should be eaten. Meals consisting solely of carbohydrates are not easy to digest, and nothing should be drunk directly before and during the meal. Digestive enhancing medication help to support the digestion.
After gastric surgery, regular check-ups are necessary.