In most cases, conservative therapy is used to treat pathologies of the gastrointestinal tract. When it is ineffective or time is lost, doctors recommend surgery. The article discusses what stomach resection is, how it is performed and what to do in the postoperative period. Sometimes such an operation is the only option to solve the patient's problems.
Description of procedure
Stomach resection is an operative method for treating gastrointestinal diseases. It is the removal of part of the affected organ and its subsequent restoration by applying an anastomosis. If the testimony requires complete removal of the stomach, then the operation will be called total gastroectomy.
Reviews of the resection of the stomach say that the operation is quite effective, and the wide possibilities of its execution allow us to find an individual approach to each patient.
The first such intervention was carried out in 1881. The founder was Theodor Billroth, in his honor one of the resection methods was named, which is actively used today.
The operation is performed under endotracheal anesthesia. She may be:
- Gentle, in which up to a third of the stomach is removed.
- Subtotal, in which you have to remove almost the entire stomach, and connect the duodenum to the esophagus.
Undoubtedly, surgery is a traumatic method of treatment and is prescribed only in extreme cases, but sometimes it alone can prolong the patient's life.
Indications for the intervention
Resection of the stomach cavity is carried out in the treatment of such diseases:
- Obesity or overweight problems. Such pathologies are increasingly found in the practice of surgeons; it is not uncommon that the surgical treatment method is most effective. The price of a stomach resection for weight loss varies within 150 thousand rubles.
- Cancer. When detecting malignant neoplasms in the stomach cavity in the early stages, doctors recommend resection. Depending on the location of the tumor, the surgeon chooses the tactics of the operation.
- Peptic ulcer caused by the digestive process. Also, an operational treatment method is recommended for patients in whom the ulcer passes to other organs and provokes bleeding.
- Gatekeeper constriction. Surgery for this diagnosis is prescribed in the case of a decompensated type of disease, the symptoms of which are similar to peptic ulcer.
Contraindications
The operation is performed only in extreme cases and is considered the last treatment. But she also has contraindications.
It is forbidden to perform a resection of the stomach in such cases:
- Localization of multiple metastases in nearby organs. If the tumor spreads outside the stomach, surgery is considered ineffective and carries a greater risk to the patient's life than benefit.
- With the accumulation of free fluid around organs, which occurs in most cases due to cirrhosis of the liver, abdominal dropsy (ascites).
- If the patient has a history of open tuberculosis.
- Renal or liver failure.
- Diabetes mellitus in case of severe disease.
- With the depletion of the body, when weight loss is pathological in nature.
Types of surgical intervention
Modern surgery has in its arsenal several methods for resection. Ample opportunities allow you to choose an individual method of treatment for each patient.
Based on the examination, analysis and examination, the doctor selects the type of stomach resection.
Depending on the volume of the removed part of the stomach, operations are divided into:
- Economical resection. In this case, 1/3 to 1/2 of the organ is removed.
- Extensive resection. It is also called typical. During surgery, approximately 2/3 of the organ is removed.
- Subtotal resection when it is necessary to cut 4/5 of the volume of the organ.
- Total resection. With this operation, about 90% of the organ is removed.
Depending on the part of the stomach on which the operation is planned, the following types of operations are distinguished:
- Distal resection - removal of the lower part of the stomach.
- Proximal resection - removal of the cardiac part and the entrance section.
- Median resection - removal of the body of the stomach, while leaving its input and output parts.
- Partial resection - removal of the affected part of the organ.
Depending on the type of anastomosis that will be applied after surgery, two resection methods are used:
- The resection of the stomach according to Billroth I. The operation involves the connection of the stump of the stomach with the input end of the duodenum. But today, this method is considered difficult due to the low mobility of the intestine and is rarely used.
- Billroth II resection is a suturing of a stump of a digestive organ into the side of the duodenum.
All Billroth operations have many modifications that surgeons successfully apply in practice.
Cancer or ulcer resection
Surgery for gastrectomy is considered the only option for treating cancer in an early stage or advanced gastric ulcer. We consider each problem in more detail.
When the diagnosis of gastric ulcer is established, the surgeons suggest cutting out a part of the organ in order to avoid relapse. Typically, 60 to 75% of tissues are resected.
The operation is performed with the removal of the antrum and pyloric departments. In the first, a special hormone is produced - gastrin, which increases the acidity in the stomach and thereby irritates its mucous membrane.
Today, such operations are performed only for patients who suffer from high acidity of the stomach. The rest is recommended for organ-preserving interventions.
If the diagnosis of malignant tumor is confirmed, then the surgeons perform a subtotal or total resection. This approach is effective in preventing relapse.
During the operation, a part of the greater and lesser omentum, lymph nodes located near the stomach are cut out. If during the intervention an overgrowth of metastases in the adjacent tissues is detected, then a combined resection is performed - the tissues of the stomach are removed along with the formations in the esophagus, liver or intestines.
Longitudinal gastrectomy
A similar operation is also referred to as "drain", vertical or sleeve resection. It represents the removal of the lateral part of the digestive organ, which significantly reduces its volume. It is this method of treatment that becomes the most popular for problems of an overweight patient.
The specifics of the intervention:
- A feature of the operation is that when a significant part of the organ is removed, all its natural valves remain, this preserves the physiology of the digestive process.
- Thanks to the longitudinal resection of the stomach, a person cannot eat a bulk portion of food, which leads to faster saturation of the body. As a result of eating smaller portions, overweight is accelerated.
- During the operation, part of the stomach is removed, in which the hormone ghrelin is produced , which is responsible for the hunger of a person. When its decrease in blood occurs, the patient ceases to feel a constant need for nutrition.
Statistics show that patients lose up to 60% of their initial weight after surgery. The procedure is carried out by the laparoscopic method using a special apparatus.
Laparoscopic gastrectomy
A similar operation is performed using a laparoscope. Its feature is minimal trauma and a shorter rehabilitation period. On the patient’s body, several small incisions are made into which the instrument and instruments for surgery are inserted. To remove the stomach with a similar method, an incision of only 3 cm will be required.
Laparoscopic surgery, compared with open, has the following advantages:
- less pronounced pain;
- mild course of the postoperative period;
- significantly lower number of postoperative complications;
- cosmetically more acceptable.
But it is worth remembering that the operation is complex and must be performed on high-quality equipment by a qualified specialist. The cost of gastric resection by this method is up to 200 thousand rubles.
The laparoscopic method is recommended for complications of peptic ulcer disease, when anti-ulcer drugs are ineffective. In the presence of malignant tumors, the method is not applied.
How to prepare for surgery?
Typically, such operations are carried out as planned. To know all the nuances and prepare, the doctor prescribes examinations:
- Urinalysis is general.
- Blood test (general, group and biochemistry).
- Blood coagulation test.
- Fibrogastroduodenoscopy.
- Electrocardiogram for assessing the condition of the heart.
- X-rays of light.
- Ultrasound of the abdominal cavity.
- Therapist is being examined.
If the patient was admitted with internal bleeding or perforation of the ulcer, then the surgeons decide on emergency resection.
Without fail, before the operation, the body is cleansed with an enema. The price of a stomach resection for weight loss is up to 150 thousand rubles.
The operation lasts about 3 hours and is performed under general anesthesia.
Stages of the intervention
The resection of the stomach is carried out according to such a plan:
- An audit of the abdominal organs is carried out and the operability of the required area is determined.
- The stomach is separated from the ligaments in order to give it mobility.
- Resection of the necessary portion of the digestive organ is performed.
- An anastomosis of the stump of the stomach and intestines is created.
- After all the manipulations, the wound is sutured and drainage is established.
Effects
Despite the cost of resection of the stomach for weight loss and many positive reviews about this operation, the patient may encounter complications. The surgeon must notify the person of all risks before surgery.
Dumping syndrome or failure syndrome.
In the postoperative period, patients note the presence of such symptoms: palpitations, dizziness, nausea and vomiting, weakness. In some cases, neurotic symptoms appear.
This complication arises from the fact that after resection, the food does not undergo the necessary processing in the stomach, but invariably enters the intestines. Food products disrupt fluid absorption and lead to complications.
There are three stages of development of complications:
- Light - manifests itself in rare attacks.
- Medium - manifested by increased blood pressure, tachycardia, nausea.
- Severe - regular attacks appear, loss of consciousness may occur, and metabolism is impaired.
Mild and moderate degrees can be treated conservatively with diet correction, and the third stage involves only surgical intervention.
Anastomazitis is a complication that manifests itself as an inflammatory process at the site of anastomosis. In this case, pain, vomiting, nausea occur. If the pathology is not treated in time, that the stomach begins to deform and a second intervention is required.
Stomach resection for weight loss or medical reasons can have consequences not only in the long term. Among the complications of the early postoperative period can be noted:
- the appearance of bleeding;
- possible infection of the wound;
- peritonitis;
- shock state of the patient;
- thrombophlebitis.
Nutrition after surgery
Carrying out a gastric resection for weight loss or for medical reasons requires following a diet in the postoperative period. Food should be taken in small portions several times a day.
Immediately after the operation, parenteral nutrition solutions are administered to the patient, since it is impossible to eat in the usual way. After a couple of days, the use of compotes, tea, decoctions is allowed. Using a feeding probe, infant formulas are administered to the patient.
Within two weeks, the diet expands and after the expiration of the term the patient can independently eat on a sparing diet.
In the postoperative period, it is recommended:
- Mainly eat mashed potatoes and soups, the basis of which are vegetables or cereals.
- Steam, oven or boil.
- Eat non-fatty meats, preferably poultry.
- Fish should also not be oily - you can eat bream, hake, cod, pike perch.
- You can eat apples without peel and vegetables in the form of mashed potatoes.
Do not use or limit:
- Exclude fried foods, preserves, smoked foods, carbonated drinks.
- Exclude bakery products in the first month after surgery. Further control consumption.
- Coarse plant foods.
- Two months after the operation, it is allowed to consume dairy products in limited quantities.
- Completely exclude salt from the diet.
It is worth remembering that the volume of food should not exceed 150 ml per serving, the frequency of food intake - 5-6 times a day.
Cost of procedure and reviews
The cost of surgery for resection of the stomach can be performed according to indications in any department of surgery for free. But it is worth remembering that a qualified specialist and modern equipment are the key to successful resection. The cost of intervention varies from 20 to 200 thousand rubles, depending on the clinic, the method of the operation. For example, a sleeve resection costs about 150 thousand rubles.
Reviews on gastrectomy are mostly positive. Patients note:
- The ability to get rid of problems with a single operation. If an ulcer or cancer is operated on, then resection helps to defeat the disease.
- In obesity, people often turn to specialists for help. Due to excess weight, they are not able to play sports, and sometimes even move around. Such an operation helps them lose weight and get in shape.
- An intervention using a laparoscope is a virtually painless procedure that is rarely accompanied by complications.
- Discomfort in the first months after surgery, because you have to eat on a strict diet and adhere to strict rules.
- The main thing is to choose a qualified specialist who does not just want to earn money, but strives to solve the patient's problems.
- Adhesion may occur.
We can say that the operation is always a last resort. But there are cases when you just can not do without intervention. Stomach resection is carried out only after a thorough examination, deliberation of all the pros and cons.