Dr. Kolachalam, Gastric (Stomach) Surgery
What is Gastric Surgery?
Gastric surgery is a procedure treating stomach cancer or stomach ulcers. The size of the affected area may vary in size from a small patch of stomach tissue to a large area of the stomach that may or may not involve other organs. In the situation of advanced stage cancer, palliative surgery, meaning that it relieves or prevents symptoms but is not done to cure the cancer, may be suggested.
The 3 main types of surgery for stomach cancer:
- Endoscopic mucosal resection: Resection refers to cutting out a tumor or part of an organ. In this operation, the cancer is removed through an endoscope (a long, flexible tube passed down the throat and into the stomach). This can be done only for some very early cancers where the chance of spread is very low.
- Subtotal (partial) gastrectomy: This approach is often used if the cancer is only in the lower part of the stomach close to the intestines. It is also sometimes used for cancers that are only in the upper part of the stomach. Only part of the stomach is removed, sometimes along with part of the esophagus or the first part of the small intestine. Nearby lymph nodes are also removed, sometimes along with other nearby organs. Eating is much easier after surgery when only part of the stomach removed. **In subtotal the lymph nodes and some of the fatty tissue (omentum) around the stomach are removed.
- Total gastrectomy: This method is used if the cancer has spread throughout the stomach. It is also often used if the cancer is in the upper part of the stomach. The surgeon removes all of the stomach. The nearby lymph nodes are removed, and sometimes also the spleen and parts of the esophagus, intestines, pancreas, and other nearby organs. The end of the esophagus is then attached to part of the small intestine. People who have had a total gastrectomy can only eat a small amount of food at a time. Because of this, they must eat more often. **In total gastrectomy, the lymph nodes and some of the fatty tissue (omentum) around the stomach are removed.
Palliative surgery for cancer that cannot be removed
For people with stomach cancer that cannot be removed (unresectable), surgery can often still be used to help control the cancer or to help prevent or relieve symptoms or problems. Even if the cancer is too widespread to be completely removed, an operation could help prevent bleeding from the tumor or keep the stomach from being blocked. This type of surgery is known as palliative surgery, meaning that it relieves or prevents symptoms but is not done to cure the cancer.
- Subtotal gastrectomy: For some people who are healthy enough for surgery, taking out the part of the stomach with the tumor can help treat problems such as bleeding, pain, or blockage in the stomach, even if it does not cure the cancer.
- Gastric bypass (gastrojejunostomy): Tumors in the lower part of the stomach may grow large enough to block food from leaving the stomach. For people healthy enough for surgery, one option to help prevent or treat this is to bypass the lower part of the stomach. This is done by linking part of the small intestine (called the jejunum) to the upper part of the stomach, which allows food to leave the stomach through the new connection.
- Endoscopic tumor ablation: In some cases, such as in people who are not healthy enough for surgery, an endoscope (a long, flexible tube passed down the throat) can be used to guide a laser beam to destroy parts of the tumor. This can be done to stop bleeding or help relieve a blockage without surgery.
- Stent placement: Another option to keep a tumor from blocking the opening at the beginning or end of the stomach is to use an endoscope to place a stent (a hollow metal tube) in the opening. This helps keep it open and allows food to pass through it.
- Feeding tube placement: Some people with stomach cancer are not able to eat or drink enough to get enough nutrition. A minor operation can be done to place a feeding tube through the skin of the abdomen and into the distal part of the stomach (known as a G tube) or into the small intestine (known as a J tube). Liquid nutrition can then be put directly into the tube.
Risks of the procedure
Surgery for stomach cancer is complex and can lead to problems. These could include bleeding from the surgery, blood clots, and damage to the nearby organs. Rarely, the new connections between the ends of the stomach and esophagus or small intestine may not hold together and can leak.
Other side effects may start after you have recovered from surgery. These could include nausea, heartburn, abdominal pain, and diarrhea (especially after eating), as well as shortages of some vitamins. The stomach is important in helping the body take in certain vitamins. If some parts of the stomach are removed, Dr. Kolachalam will prescribe vitamin supplements. Some of these can only be taken only as shots (injections). After stomach surgery, most people will need to change their diets, eating smaller meals more often.
It is very important that you talk to Dr. Kolachalam before surgery about what you are going to have. Dr. Kolachalam will try to leave behind as much of the stomach as he can so that you will have fewer problems later. But the tradeoff is that the cancer might be more likely to come back.
As with any surgical procedure, complications may occur. Some possible complications include, but are not limited to, the following:
- Blood clots
- Bleeding ulcer
- Development of gallstones
- Gastrointestinal hemorrhage
What to expect before your procedure:
- Dr. Kolachalam will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
- You will be asked to sign a consent form that gives Dr. Kolachalam permission to perform the procedure. Read the form carefully and ask questions if something is unclear.
- In addition to a complete medical history, Dr. Kolachalam may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
- You will be asked to fast for eight hours before the procedure, generally after midnight.
- If you are pregnant or suspect that you are pregnant, you should notify Dr. Kolachalam.
- Notify Dr. Kolachalam if you are sensitive to or are allergic to any medications, latex, iodine, tape, or anesthetic agents (local and general).
- Notify Dr. Kolachalam of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
- Notify Dr. Kolachalam if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, ibuprofen, naprosyn, or other medications that affect blood clotting. It may be necessary for you to stop some of these medications prior to the procedure.
- You may be asked to begin exercising and alter your diet several weeks before surgery.
- If you are a woman of child-bearing age, you may receive birth control counseling so that you do not become pregnant in your first year after surgery due to the risk to the fetus from rapid weight loss.
- You may receive a sedative prior to the procedure to help you relax.
- Based upon your medical condition, Dr. Kolachalam may request other specific preparation
What to expect during the procedure:
Gastric surgery requires a stay in the hospital. Procedures may vary depending on which type of procedure is performed. Gastric surgery is generally performed while you are asleep under general anesthesia.
Generally, gastric surgery follows this process:
- You will be asked to remove clothing and will be given a gown to wear.
- An intravenous (IV) line will be started in your arm or hand.
- You will be positioned lying on your back on the operating table.
- A urinary catheter may be inserted into your bladder.
- If there is excessive hair at the surgical site, it may be clipped off.
- The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin over the surgical site will be cleansed with an antiseptic solution.
- For an open procedure, Dr. Kolachalam will make a single large incision in the abdominal area. For a laparoscopic procedure, a series of small incisions will be made on the abdomen. Carbon dioxide gas will be introduced into the abdomen to inflate the abdominal cavity so that the stomach and other structures can easily be visualized with the laparoscope.
- For an open procedure, the abdominal muscles will be separated and the abdominal cavity will be opened. For a laparoscopic procedure, Dr. Kolachalam will insert the laparoscope and other small instruments.
- A drain may be placed in the incision site to remove fluid.
- The incision will be closed with sutures or surgical staples.
- A sterile bandage/dressing will be applied.
What to expect after the procedure:
In the hospital:
After the procedure, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Weight loss surgery usually requires an in-hospital stay of several days.
You may receive pain medication as needed, either by a nurse or by administering it yourself through a device connected to your intravenous line.
You will be encouraged to move around as tolerated while you are in bed, and then to get out of bed and walk around as your strength improves. This is very important, as it helps to prevent blood clots from forming.
At first you will receive fluids through an IV. After a day or two you will be given liquids, such as broth or clear juice, to drink. As you are able to tolerate liquids, you will be given thicker liquids, such as pudding, milk, or cream soup, followed by foods that you do not have to chew, such as hot cereal or pureed foods. Dr. Kolachalam will instruct you about how long to eat pureed foods after surgery. By one month after your procedure, you may be eating solid foods.
You will be instructed about taking nutritional supplements to replace the nutrients lost due to the reconstruction of the digestive tract.
Before you are discharged from the hospital, arrangements will be made for a follow-up visit with Dr. Kolachalam.
Once you are home, it will be important to keep the surgical area clean and dry. Dr. Kolachalam will give you specific bathing instructions. The sutures or surgical staples will be removed during a follow-up visit.
The incision and abdominal muscles may ache, especially with deep breathing, coughing, and exertion. Take a pain reliever for soreness as recommended by Dr. Kolachalam. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications. Managing-Your-Pain-After-Surgery PDF
You should continue the breathing exercises used in the hospital.
You should gradually increase your physical activity as tolerated. It may take several weeks to return to your previous levels of stamina.
You may be instructed to avoid lifting heavy items for several months in order to prevent strain on your abdominal muscles and surgical incision.
Weight loss surgery can be emotionally difficult because you will be adjusting to new dietary habits and a body in the process of change. You may feel especially tired during the first month following surgery. Exercise and attending a support group may be helpful at this time.
Notify Dr. Kolachalam to report any of the following:
- Fever and/or chills
- Redness, swelling, or bleeding or other drainage from the incision site
- Increased pain around the incision site
Following gastric surgery, Dr. Kolachalam may give you additional or alternate instructions, depending on your particular situation.