Gastrectomy

PROCEDURE OF THE DAY

Gastrectomy

A gastrectomy is a partial or full surgical removal of the stomach.


Indications

Gastrectomies are performed to treat cancer and perforations of the stomach wall.

In severe duodenal ulcers it may be necessary to remove the lower portion of the stomach called the pylorus and the upper portion of the small intestine called the duodenum. If there is a sufficient portion of the upper duodenum remaining a Billroth I procedure is performed, where the remaining portion of the stomach is reattached to the duodenum before the bile duct and the duct of the pancreas. If the stomach cannot be reattached to the duodenum a Billroth II is performed, where the remaining portion of the duodenum is sealed off, a hole is cut into the next section of the small intestine called the jejunum and the stomach is reattached at this hole. As the pylorus is used to grind food and slowly release the food into the small intestine, removal of the pylorus can cause food to move into the small intestine faster than normal, leading to gastric dumping syndrome.

Polya's operation

A type of posterior gastroenterostomy which is a modification of the Billroth II operation. Resection of 2/3 of the stomach with blind closure of the duodenal stump and retrocolic anastomosis of the full circumference of the open stomach to jejunum

History

The first successful gastrectomy was performed by Theodor Billroth in 1881 for cancer of the stomach.

Historically, gastrectomies were used to treat peptic ulcers.[1] These are now usually treated with antibiotics, as it was recognized that they are usually due to Helicobacter pylori.

In the past a gastrectomy for peptic ulcer disease was often accompanied by a vagotomy, to reduce acid production. Nowadays, this problem is managed with proton pump inhibitors.



VIDEO




This video shows the vertical sleeve gastrectomy, a new option for surgical treatment of severe and morbid obesity. It does not require rerouting of the bowel, and is therefore safer than the gastric bypass. It has a very low complication rate; most patients can go home within 24 hours of the procedure. For more information go to www.laparoscopy.com/pleatman

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