Gastrectomy

If you would like to know about Gastrectomy surgery, and the benefits of gastrectomy, the following information will be of interest to you.

Before you agree to have surgery to treat your stomach ulcer it is important to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your choice of treatment for your stomach ulcer with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

The most likely problem is that there is an ulcer in your stomach. You may have had tiny ulcers in your mouth as a child. A stomach ulcer is much bigger. An ulcer means that the surface cells have been lost; causing a break in the stomach lining that steadily deepens. It may burrow into an artery in the wall of the stomach. It can burrow right through the stomach wall to burst into the tummy cavity.

The ulcer may scar up, causing the upper end of the stomach to narrow. This makes swallowing difficult. It can narrow the lower end of the stomach, causing vomiting.

Other treatments have not worked. You now need to have the ulcer removed with some or all of your stomach.

What is the stomach?

The stomach is a muscular pouch lying between the gullet (oesophagus) and the first part of the bowel, called the duodenum.

The lining of the upper part of the stomach produces acid and a digestive chemical called pepsin. Together with the action of the stomach muscle, these chemicals break down food and drink to produce a fine paste.

The cells lining the lower part of the stomach control how much acid and pepsin is made in the upper part of the stomach.

A ring muscle, called the pylorus, at the outlet of the stomach, relaxes from time to time, to let the food paste through into the duodenum.

It is important to know these facts, to understand about operations on ulcers.

What has gone wrong?

The most common cause for an ulcer is a tumour in the stomach lining. This is also called a cancer or malignant cancer.

The malignant cells come from the lining of the stomach wall.  At first the cells stay within the lining of the stomach (in-situ carcinoma). Later they spread into the wall of the stomach (invasive cancer), making a deep ulcer. The ulcer can become fixed to the nearby tissues, such as the bowel or liver. Some of the bowel or the liver may need to be removed to clear the tumour.

The malignant cells can spread into the nearby lymph glands. The lymph glands are the same as the glands you feel in your neck when you have a sore throat. Malignant cells in the lymph glands suggest that there may be malignant cells in other parts of the body such as in the liver or lungs. If so, drug treatment may be needed after the operation. We normally remove these glands during the operation and send them for examination under the microscope.

Sometimes the malignant cells have spread widely throughout the stomach. The whole stomach then needs to be removed.

Sometimes the malignant cells in the stomach are lymph cells. The tumour is called a lymphoma. Different types of drug treatment may be needed after the operation.

A less common type of ulcer is a peptic ulcer. This is caused by too much stomach acid and pepsin. These may form in the duodenum as well as in the stomach. These days, most peptic ulcers are healed with drugs, but some need surgery. In some cases, an operation is needed because it is not clear whether the ulcer is peptic, or could be malignant.

The aims

The aim is to remove any malignant tumour with some or all of the stomach. Some of the oesophagus or duodenum may also need to be removed. This will be to get a clear area of healthy tissue to minimise the chance of the ulcer coming back. The nearby lymph glands need to be removed, to see whether there are any malignant cells in them. If so, drug treatment may be needed in the future.

The main aims of an operation for a peptic ulcer are to stitch up any bleeding artery and to close any burst (perforation). Modern powerful drugs cut down the acid so that the ulcer heals. If the drugs are not working well, an operation can do this. In the operation, we remove the acid controlling, lower, part of the stomach, and not the upper half. Less acid and pepsin is now produced so, the ulcer should heal up, whether it is in the stomach or the duodenum. 

You will be asleep with a general anaesthetic during the operation.

The benefits

The operation will stop any bleeding ulcer, seal any burst ulcer, and remove malignant disease. It should relieve any difficulty swallowing and stop the vomiting.

Are there any alternatives?

Medicines and tablets will not be helpful a malignant tumour. Neither would x-ray or laser treatment.

If there is a blockage to the entrance of the stomach, a special tube can be passed down the oesophagus to hold the narrow part open. This is a good treatment for someone who is not fit enough for an operation.

Sometimes an operation to bypass the diseased part in the stomach is better than removing the stomach. We can only usually decide an alternative like this during the operation.

The vagus nerve controls acid release into the stomach. An operation to cut the vagus nerve to the stomach, called a vagotomy, instead of removing the stomach, would be an alternative in many cases of peptic ulcer. Your specialist can discuss this with you.

What if you do nothing?

Waiting and seeing if the condition will get better is not a good plan. Any troubles you have noticed will get worse. Other serious problems may well appear.

Author: Mr Michael Edwards FRCSEng FRCSEd. Consultant general surgeon.

© Dumas Ltd 2006

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