The stomach is important as the reservoir for food after meals. Furthermore, the stomach produces hydrochloric acid, hormones and the so called „intrinsic factor“, which is responsible for the absorption of Vitamin B12 from the food. This is important because Vitamin B12 needs to be replaced externally after complete removal of the stomach. Operations were necessary 20 years ago mostly for gastric ulcers. Due to better medication to block gastric acid nowerdays this is a rare indication. More frequently it is necessary due to gastric cancer or chronic gastric acid reflux disease.
Operations for gastric acid reflux
The most frequent operation due to reflux of gastric acid in the lower end of the esophagus is the so called „fundoplication“. Here the upper part of the stomach is wrapped around in the lower esophagus in a losse fashion. Once the stomach is filled with food, this wrap is filled like a pillow with stomach content and is pushing on the distal esophagus and in this way prevents reflux. This procedure that is mostly performed in minimally invasive fashion is not very stressful for the patient, but prevents life-long medication with proton pump inhibitors that block gastric acid. Hospitalisation is between 3 and 5 days.
Operations for gastric cancer
The exact way to operate the stomach is dependent of the position of the cancer and ist bilogical aggressiveness. Standard operation in the less aggressive „intestinal type“ (Classification of Lauren) ist he subtotal gastric resection, which means to preserve about 20-30% of the stomach, which can increase in size somewhat later. Frequently, the so called “diffuse type” is present which necessitates the complete removal of the stomach. Also in stomach cancer surgery the local lymph node stations are removed along with the stomach /D2 Lymphadeectomy). Reconstruction is done by small bowel pull-up and connection of the to the remnant of the stomach or the remaining esophagus. Complications are related to the anstomosis between the esophagus/gastric remnant and/ort he small bowel which can present with deficient healing and leakage. The duration of hospital stay is between 8 and 12 days.