What is Gastrectomy?

[Lorenzo]

Gastrectomy: Is the surgical removal of the stomach, or parts of the stomach. Indications may be pertaining to bariatric in nature in controlling a patient's weight, or can be due to the presence of benign tumor(s) in the gastric viscera.

[Lorenzo]

[Lorenzo]

[Lorenzo]

The surgical removal of part of the stomach:

[Lorenzo]

The first part of the operation was pretty straight forward. The blood supply and nerves of the stomach was cut. Using an instrument called GIA, which places two double rows of staples and cuts between them in one move, the duodenum and stomach was divided below the pylorus. The esophagus was separated from the stomach the same way. The spleen was then dissected and the operation specimen was removed.

[Lorenzo]

The second part took a little more thinking on my part before I understood the plumbing. No disrespect to the gastrointestinal surgeons, but this really was advanced plumbing. OK. Remember that both the esophagus and the upper part of the duodenum is closed. One could think that these ends were going to be joined together, but no. Most of the gastric juices enter the small intestine in the duodenum from the pancreatic duct and the common bile duct. If the duodenum was connected directly to the esophagus, bile could enter the esophagus and cause problems. So another solution has to be found.

[Lorenzo]

First the surgeons separated the lower part of the duodenum from the jejunum with the GIA, sealing both ends. Then they made an anastomosis between the esophagus and the jejunum 40 cm below the ligament of Treitz. Finally they made an anastomosis between the bottom part of the duodenum and the jejunum 40 cm below the first anastomosis. The upper part of the duodenum was left closed. So the food would go directly from the esophagus to the jejunum, and join with the gastric juices from the duodenum after 40 cm. The surgeons explained it to me as they were working, but I didn’t really get it until I looked up an illustration in a book the next day (photo credit). Advanced plumbing indeed.


The surgical procedure is quite straightforward.

[Lorenzo]

My first observation of a gastrectomy was rather interesting. The procedure took less than 2 hours. All together, from prepping the patient till the end, took around 5 hours.

Kuyaw kaayo.