Gastrectomy
Preparation:
As for general anaesthetic. In addition further investigations may be required depending upon the underlying condition
Procedure:
The clinical condition requiring surgery will determine the amount of the stomach that has to be removed. This may require an open operation or a laparoscopic procedure.
Anaesthetic:
General
Post Op:
Patients will generally require close observation in the early post operative period. This will be provided in a high dependency setting which will allow a specialist nurse to provide close monitoring. Fluids and diet will gradually be reintroduced over the first week post op and patients will be encouraged to mobilise over this period. It is likely that in the post operative period fluids will be provided using a drip and that a catheter will be inserted into the bladder to allow close observation of the urine output. The biggest problem in the convalescent period is adjustment to the constraints of a new diet, all patients will find that after a gastrectomy their ability to take the same quality of food is reduced. For many the only problem is one of adjusting to eating smaller and more frequent meals but for others there may be more significant problems and long term monitoring of weight and nutrition is required. Patients who undergo a complete excision of the stomach will have problems absorbing iron and vitamin B12 – they are likely to require iron supplements and vitamin replacement.
A gastrectomy is a major operation and although usually a very straight forward operation there is a risk of complications. These can be regarded as non-specific complications related to having an anaesthetic and being immobile in bed for some time and those specific to the operation. The non-specific complications include:
- Chest infections – more common in smokers or patients with pre-existing lung diseases. Prophylactic physiotherapy will hopefully prevent this complication developing.
- Venous thrombosis and pulmonary embolism – patients will be given drugs to thin the blood and try to prevent this and will receive physiotherapy and early mobilisation to minimise the risks.
- Cardiac complications -these are uncommon unless there is a specific risk factor in this situation appropriate measures will be taken to minimise the risks.
The specific complications of a gastrectomy include:
- a wound infection - a wound infection is usually manifest as pain, swelling and redness around the wound it may or may not discharge pus. In most cases a wound infection is treated with antibiotics.
- delayed return to normal gut function – this is known as an ileus and may require longer than normal intravenous fluids. In the most prolonged cases treatment with intravenous nutrition may be required.
- leakage from the join between the small bowel and the stomach or oesophagus – this may necessitate further surgery.
- a hernia through the wound -this is obviously more common with open surgery and may require an additional operation to repair it.
OPC Codes:
G2710 Total Gastrectomy
G2800 Partial Gastrectomy
