Subtotal Gastrectomy Surgery

Procedure and Overview

A subtotal gastrectomy is a surgical procedure involving the removal of a portion of the stomach, typically the area affected by cancer or tumors. The procedure often includes the removal of nearby lymph nodes and, in some cases, parts of adjacent affected organs. For early-stage diseases, particularly distal-third and middle gastric cancers, subtotal gastrectomy is preferred due to comparable survival rates and better functional outcomes compared to total gastrectomy.

Alternate Names

Partial gastrectomy
Billroth II

Target Area

Stomach

Preparation for Subtotal Gastrectomy

To ensure a smooth procedure and recovery, specific preparatory steps are required:

Discontinuation of medications or supplements that may interfere with blood clotting approximately one week before surgery.
Overnight fasting to ensure the stomach is empty for the procedure.
Pre-operative diagnostic tests, such as blood tests, as advised by the surgeon.
Admission to the hospital is typically required for a few days to weeks, depending on the case.
The procedure is performed under general anesthesia, ensuring a pain-free experience.

Procedure Details

Types of Surgery

Open Surgery:
- A single incision is made from the upper mid-abdomen to the navel to access the stomach and surrounding organs.
- Adjacent organs and lymph nodes are examined for cancer spread.
- Affected stomach portions are removed, and the remaining section is connected to the duodenum or small intestine using stitches.
Laparoscopic Surgery:
- Several small incisions are made in the abdomen.
- A laparoscope, equipped with a camera, is inserted to guide the surgeon.
- Surgical tools are used to remove the affected stomach parts and reconnect the remaining portions internally.

In both techniques, fluid drainage is conducted post-surgery.

Recovery Process

Hospital Stay: Patients typically remain hospitalized for 6–10 days for close monitoring and recovery.
Symptom Monitoring: Immediate medical attention is required for high fever, excessive bleeding, severe pain, or unusual symptoms.
Diet: Small, frequent, nutritious meals are recommended. Acidic and late-night foods should be avoided to reduce reflux.
Medication: Pain relief medications are prescribed to manage discomfort as the wound heals.

Wound Care:

Change dressings as needed. Once drainage ceases, wounds can be left uncovered.

Rest and Activity:

Adequate rest is essential. Avoid strenuous activities for a specified period to ensure proper healing.

Post-Surgery Follow-Up

Initial Monitoring: A nasal tube is inserted to keep the stomach empty and is removed when bowel function normalizes.
Nutritional Support: IV nutrition is provided until oral intake resumes. Liquid foods transition to solids gradually under medical supervision.
Tube and Stitch Removal: Drains, catheters, and stitches are typically removed within 8–10 days, followed by discharge.

Regular Follow-Ups:

A follow-up appointment within 1–3 weeks post-discharge is crucial for assessing recovery and addressing any complications.

Risks Associated with Subtotal Gastrectomy

As with any surgical procedure, subtotal gastrectomy carries certain risks, including:

Blood clots in the legs.
Nutritional deficiencies leading to complications such as weak bones, reduced immunity, or anemia.
Weight loss.
Bleeding or incisional hernia.
Digestive issues like acid reflux, nausea, vomiting, or diarrhea.
Dumping syndrome, which can cause dizziness, sweating, and nausea due to rapid food transit to the intestine.
Bowel narrowing due to scar tissue formation.
Potential damage to nearby organs.

Conclusion

Subtotal gastrectomy is a vital treatment for specific stomach conditions, offering effective outcomes for early-stage gastric cancers. While it involves certain risks, careful preparation, skilled surgical execution, and dedicated post-operative care can help ensure a smooth recovery and improved quality of life.

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