Brief Note on Gastrectomy

In this article, we will discuss Brief Note on Gastrectomy. So, let’s get started.

Gastrectomy

It is the removal of all or part of the stomach; Gastrectomy was mostly used as a treatment for stomach and duodenal ulcers, however, now this procedure is used primarily for cancer of the stomach; Types are partial and total gastrectomy.

Causes

• Peptic ulcer (gastric/duodenal)
• Pyloric stenosis
• Zollinger-Ellison syndrome (hypergastrinaemia)
• Malignancy (gastrinoma)

Operations

• Vagotomy
• Pyloroplasty
• Gastrojeunostomy
• Antrectomy (1/3 of stomach is excised)
• Partial gastrectomy (2/3 of distal stomach is excised)
• Total gastrectomy
– Billroth I – gastro-duodenal anastomosis-meant for gastric ulcer
– Polya operation-gastro-jejunal anastomosis meant for duodenal ulcer
• Sleeve gastrectomy
Incisions used – Upper midline incision

Complications

Respiratory, circulatory and electrolyte imbalance are common with gastrectomy surgery.
• Early complications (It may occur within a year of surgery):
– Paralytic ileus, stomal obstruction, duodenal blow out, post dumping syndromes, pancreatitis, vomiting.
• Late complications:
– Recurrent ulcer, fistula, nutritional deficiency, intestinal obstruction, TB, gallstones

Postoperative Care

• Nasogastric tube in situ (2 hourly suction)
• 3rd day liquid diet
• 5th or 6th day normal diet

Depending on the severity of the surgery, the patient may be sent to a regular surgical room or may be sent to the surgical intensive care unit to be more closely monitored. The nasogastric tube is left in place and connected to suction to keep the stomach empty. The tube is removed when stomach and bowel function returns to normal, usually in 2–3 days; Fluids are given by vein (intravenously, IV).The Antibiotics are usually given IV for 24 hours; Oxygen may be given by nasal catheter, if necessary. Gradually the diet is increased from liquids to soft food and then more solid foods. A special diet may be necessary for many of the patients with a gastrectomy. The wound is kept clean to prevent infection. Lotions should not be applied on the wound. If radiation therapy or chemotherapy is given, there will be follow-up with a radiologist or oncologist. Blood tests, CT scans and other diagnostic tests may be necessary to follow the course of the disease.

Physiotherapy

Common preoperative assessment and training the patient for the effective postoperative care.

Postoperative Assessment and Management

Problems

• Increased production of mucus secretions of lower lobe of left lung
• Inhibited cough reflex due to pain & Ryle’s tube
• Tiredeness-Anaemia-less RBC production
• Haemetemesis

Treatment

• Chest physiotherapy
• Encourage cough reflex
• Treat for short duration to avoid fatigue
• Arm/leg exercises
• Early mobilization-prop up position achieved in the evening or next day
• Wound care
• Micturition/bowel management
• Pain relief -TENS could be used
• Oral hygiene
• Diet

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