Gastrectomy

Gastrectomy is a surgical procedure to remove all or part of the stomach, most commonly used to treat stomach cancer but also performed for other conditions. While you can live and eat without a stomach, this major surgery significantly changes how you digest food and requires lifelong adjustments to your diet and lifestyle.

Table of contents

• What is a gastrectomy?
• Types of gastrectomy
• Why is gastrectomy performed?
• Preparing for surgery
• What happens during the operation
• Recovery and hospital stay
• Life after gastrectomy
• Changes to eating and nutrition
• Possible complications and side effects
• Taking medications after gastrectomy
• Long-term outlook

What is a gastrectomy?

A gastrectomy is a surgical procedure that removes all or part of your stomach^[1]. Your stomach is a muscular, J-shaped organ in your digestive system that stores food and begins breaking it down before it moves into your small intestine^[2]. The stomach processes nutrients and digestion by partially digesting food before passing it along to the intestines^[3].

Although removing your stomach changes how your digestive system works, you can live a full and active life without a stomach^[4]. Your small intestine can still absorb nutrients, but the way you eat will need to change significantly^[5].

Types of gastrectomy

There are several types of gastrectomy, and the type you have depends on where the problem is in your stomach and how serious it is^[6].

Total gastrectomy removes your entire stomach. The surgeon connects your food pipe (esophagus) directly to your small intestine^[7]. This is sometimes necessary when cancer is in the middle or upper part of the stomach.

Partial gastrectomy (also called subtotal gastrectomy) removes part of your stomach, often the lower portion^[8]. How much is removed depends on the location of the disease. A subtotal gastrectomy typically removes about 80% of your stomach^[9]. The remaining part of your stomach is reconnected to your small intestine.

Sleeve gastrectomy removes the left part of the stomach, creating a tube-shaped stomach about the size and shape of a banana^[10]. This type is often used for weight loss surgery.

Esophagogastrectomy removes the upper part of the stomach along with part of the food pipe^[11]. This is done when cancer is located where the stomach joins the esophagus.

During any of these operations, your surgeon will also remove nearby lymph nodes (small glands that are part of your immune system) to check if disease has spread to them^[12].

Why is gastrectomy performed?

Gastrectomy is most commonly performed to treat stomach cancer (also called gastric cancer). The surgery aims to remove the tumor completely and prevent cancer from spreading^[13]. Even when the cancer cannot be completely removed, a partial gastrectomy may provide relief from symptoms like pain and bleeding^[14].

Other conditions that may require gastrectomy include^[15]:

• Non-cancerous (benign) tumors that cause symptoms or may become cancerous
• Bleeding ulcers that cannot be controlled with medication
• Inflammation of the stomach lining (gastritis) that causes severe symptoms and does not respond to medicine
• Holes (perforations) in the stomach wall
• Severe peptic or duodenal ulcers
• Non-cancerous growths called polyps
• Severe obesity that is harming your health
• Injuries that have damaged stomach tissue beyond repair

Some people choose to have their stomach removed to prevent hereditary diffuse gastric cancer if they carry a harmful mutation in a gene called CDH1^[16]. People who inherit this mutation from a biological parent have a very high risk of developing stomach cancer that is nearly impossible to detect early^[17].

Preparing for surgery

Before your operation, you will need to attend a pre-assessment appointment where your general health and fitness for surgery will be checked^[18]. You will be asked about your medical history and any medicines you are taking. The healthcare team will perform routine tests such as blood tests, an electrocardiogram (heart tracing), chest X-ray, and lung function tests^[19].

If you smoke, it is vital that you try to stop immediately. Smoking slows recovery and increases the risk of getting a chest infection after surgery^[20]. Taking regular, gentle exercise and eating well before surgery is very important to get in the best shape possible^[21].

You may need to temporarily stop taking medicines that keep your blood from clotting (blood thinners), including over-the-counter medicines like aspirin and ibuprofen^[22]. Your doctor will tell you which medicines to stop and when.

You will usually be admitted to the hospital the day before your operation^[23]. You will not be allowed to eat or drink anything for 4 to 6 hours before surgery^[24]. Special stockings will be applied to your legs to help prevent blood clots (deep vein thrombosis)^[25].

What happens during the operation

Gastrectomy is performed under general anesthesia, which means you will be asleep and pain-free during the surgery^[26]. The operation can take between 4 to 5 hours^[27].

There are two main ways the surgery can be done:

Open surgery involves making a large cut (incision) through your abdominal wall. The surgeon removes all or part of your stomach through this opening^[28]. The incision is later closed with staples or stitches.

Laparoscopic surgery (also called keyhole surgery) uses several small cuts instead of one large one. The surgeon inserts small instruments and a tiny camera through these openings^[29]. This approach often results in faster recovery, less pain, and smaller scars^[30]. Some surgeons also use robotic-assisted techniques for this procedure.

During the operation, the surgeon will remove the diseased part of your stomach and nearby lymph nodes. Depending on which type of gastrectomy you have, the surgeon will then reconnect your digestive system. After a partial gastrectomy, your remaining stomach is connected to your small intestine. After a total gastrectomy, your food pipe is connected directly to your small intestine^[31].

Recovery and hospital stay

You may stay in the hospital for 6 to 10 days after surgery^[32]. For the first few days, you will not be able to eat any food. Instead, you will be fed through a tube in your vein or a catheter that goes into your belly^[33]. There may also be a tube in your nose to help keep your stomach area empty, which is removed once your bowels are working well again^[34].

Most people experience pain after the surgery. You will receive pain medicine, and you should tell your surgeon when you are having pain and whether the medicines are helping^[35].

Getting up and walking is very important for your recovery. Moving about will wake up your body’s systems and help speed up healing^[36]. It helps prevent pneumonia, constipation, and blood clots.

After about a week, you should be ready to start a light diet again, beginning with clear liquids^[37]. A dietitian will help you slowly build up to eating solid foods, which usually takes 4 to 6 weeks^[38].

It usually takes 6 to 8 weeks to heal from a gastrectomy and get back to your usual activities, though it can take up to a year to recover fully^[39]. You will need to avoid heavy lifting for at least 6 weeks after surgery^[40]. You should be able to return to work 2 to 4 months after surgery, depending on the type of work you do^[41].

Life after gastrectomy

Living without a stomach or with a much smaller stomach will change your life, but these changes should not stop you from living fully^[42]. After surgery, your digestive system works differently, and you will need to make permanent changes to how you eat and live.

Weight loss is expected after gastrectomy. Weight loss is fastest in the first month after surgery and continues gradually for 6 to 12 months^[43]. This weight loss includes both fat tissue and muscle mass. Note that it is harder to regain weight after a total gastrectomy^[44].

You may not feel hungry after surgery because your body no longer sends the usual signals to tell you to eat^[45]. You may need to set timers or other reminders to eat throughout the day. Even if you are not hungry, it is important to remember that nutrition is vital for your health^[46].

Eventually, the desire to eat and enjoy food will return^[47]. Many people learn to adapt well and live full lives after gastrectomy.

Changes to eating and nutrition

Without your stomach, you cannot handle regular portions of food. Your body also cannot grind food or digest and absorb every nutrient as effectively as before^[48].

Here are the key eating changes you will need to make^[49]:

• Eat 6 to 8 small meals throughout the day instead of 3 large meals
• Take small bites and chew your food very well
• Eat slowly, taking 20 to 30 minutes for each meal
• Stop eating and drinking as soon as you feel full
• Drink fluids between meals instead of during meals
• Stay upright for some time after eating

Right after surgery, you will feel full after only a few bites of food, approximately 1 to 2 ounces at a time (about the amount that fills a shot glass)^[50]. As your body adapts over 6 to 12 months, you will gradually be able to increase portion sizes to child-size meals.

It is important to consume as many calories as possible to minimize rapid weight loss in the first few months and to take in nutrients your body needs for healing^[51]. Focus on eating high-calorie and high-protein foods.

You may need to avoid or limit certain foods^[52]:

• High-fiber foods like beans, lentils, and whole grains can fill you up too quickly at first
• Dairy products may cause gas, bloating, and diarrhea if you develop difficulty digesting lactose (milk sugar)
• Raw vegetables, nuts, seeds, and crusty breads may be hard to digest
• Carbonated beverages should be avoided
• Alcohol should be discussed with your doctor, as your body may absorb it more quickly

Possible complications and side effects

Like any major surgery, gastrectomy carries risks^[53]. Possible complications include:

• Infection at the incision site or inside the body
• Bleeding
• Blood clots
• Reactions to anesthesia
• Damage to nearby organs
• Leaking from connections in your digestive tract
• Narrowing at the connection points, causing blockage

Dumping syndrome is a common problem after gastrectomy. This happens when food moves too quickly from your stomach (or where your stomach used to be) into your small intestine^[54]. It can cause nausea, diarrhea, sweating, feeling faint, shaky, nauseated, and abdominal cramps. To prevent dumping syndrome, avoid high-sugar foods, include protein and healthy fats with meals, and eat slowly^[55].

After gastrectomy, you are at risk for deficiencies in certain vitamins and minerals, particularly vitamin B12, iron, calcium, and vitamin D^[56]. This is because parts of your digestive system that help absorb these nutrients have been removed. You will likely need to take vitamin supplements every day for the rest of your life.

Other long-term issues can include^[57]:

• Acid reflux or bile reflux
• Diarrhea
• Nausea or vomiting
• Difficulty swallowing
• Bone disease due to vitamin D and calcium deficiency

More than 90% of people who had total gastrectomy to prevent hereditary diffuse gastric cancer experienced at least one chronic complication, and about a quarter said the complications were life-altering^[58].

Taking medications after gastrectomy

How your body absorbs oral medications (pills taken by mouth) changes after gastrectomy^[59]. Without your stomach and upper small intestine, there is less time and surface area for drug absorption.

After gastrectomy^[60]:

• Review all medications with a clinical pharmacist or your care team
• Some medications may be switched to different forms, such as patches, liquids, or medications placed under the tongue
• You may be able to crush some pills or open capsules to help absorption, but always check with your pharmacist first
• Avoid timed or controlled-release medications (labeled ER, XR, or CR)
• Pain medications may be absorbed more quickly, so lower doses may be needed
• Avoid oral birth control pills, as they may not be absorbed well enough to be effective

Long-term outlook

While gastrectomy is a life-changing surgery, many people go on to live full and active lives. The surgery often has favorable results in controlling symptoms and improving quality of life^[61].

Long-term survival and outcomes depend on many factors, including the reason for surgery, the stage of disease (if cancer), your overall health, and how well you follow dietary and lifestyle recommendations^[62].

Working closely with your healthcare team, including surgeons, dietitians, and other specialists, is essential for the best outcomes^[63]. Regular follow-up appointments will be needed to monitor your nutrition, check vitamin levels, and address any complications that develop.

It is important to be prepared for the real impact of this operation. As one surgeon emphasized, “It’s not that surgery might change your life, it will change your life”^[64]. However, with proper support and adjustments, people can adapt well to life after gastrectomy.