Gastrectomy is a surgical procedure that removes part or all of the stomach, fundamentally changing how the body processes food and requiring significant lifestyle adjustments for those who undergo this operation.

What Is Gastrectomy?

A gastrectomy is a surgical procedure involving the removal of all or part of the stomach. This major operation changes your digestive system significantly, though people can live and eat without a stomach. The stomach normally acts as a food reservoir where food is stored and broken down before traveling to the small intestine to absorb nutrients^[1].

There are two main types of gastrectomy procedures. A total gastrectomy removes the entire stomach, while a partial gastrectomy removes only part of the stomach. Partial gastrectomies have several variations depending on how much stomach tissue is removed. For example, a subtotal gastrectomy removes about 80% of the stomach. Some procedures are named based on their purpose, like sleeve gastrectomy, which is a partial gastrectomy performed to treat severe obesity^[10].

When surgeons remove the stomach, they must reconstruct the digestive system by creating new connections. After a total gastrectomy, the small intestine is connected directly to the esophagus, bypassing the stomach entirely. After a partial gastrectomy, the remaining portion of the stomach is reconnected to the small intestine. This reconstruction allows food to continue moving through the digestive system, though in a very different way than before^[1].

Why Gastrectomy Is Performed

Gastrectomy most commonly treats stomach cancer, also called gastric cancer. Worldwide, gastric cancer ranks as the fifth most common cancer and the third leading cause of cancer-related death. There are over one million new cases globally each year, with approximately 27,500 new diagnoses in the United States alone^[8].

The surgery aims to completely remove the cancer or prevent it from spreading. When cancer is located in different parts of the stomach, surgeons must decide how much of the organ to remove. If the cancer is in the lower part of the stomach, a partial gastrectomy may suffice. However, when cancer is in the middle or upper portions, or has spread more extensively, a total gastrectomy may be necessary. During the operation, surgeons also remove nearby lymph nodes to check if cancer has spread and to reduce the risk of recurrence^[8].

Beyond cancer treatment, gastrectomy can address several other medical conditions. These include non-cancerous tumors that cause symptoms or may become cancerous, severe inflammation of the stomach lining called gastritis that does not respond to medication, and peptic ulcer disease involving stomach sores that damage the stomach lining. The procedure may also treat life-threatening obesity through bariatric surgery, or repair injuries that have damaged stomach tissue beyond repair^[5].

Some people choose to have their stomach removed preventively to avoid hereditary diffuse stomach cancer. This rare form of cancer develops in people who inherit a mutation in a gene called CDH1 from a biological parent. Because this cancer is extremely difficult to detect early when treatments work best, doctors may recommend total gastrectomy for people who carry this genetic mutation^[3].

The Surgical Procedure

Gastrectomy can be performed using different surgical approaches. The traditional method is open surgery, where the surgeon makes a large incision through the abdominal wall. Alternatively, surgeons can perform laparoscopic surgery, also called keyhole surgery, using small incisions and specialized instruments with cameras. Some centers also offer robot-assisted gastrectomy. The laparoscopic approach typically results in faster recovery, less pain, and smaller scars compared to open surgery^[6].

The surgery is performed under general anesthesia, meaning you are completely asleep and pain-free during the procedure. The operation typically takes between four to five hours when performed as open surgery. During the procedure, the surgeon removes the diseased portion of the stomach and may also remove nearby tissues, including lymph nodes and parts of the omentum, which is the sheet of tissue that holds the stomach in place^[4].

How the surgeon reconstructs the digestive system depends on which type of gastrectomy was performed. After a partial gastrectomy removing the lower stomach, the surgeon cuts the small bowel and connects its middle section to the remaining upper stomach. The valve between the esophagus and stomach remains in place. After a total gastrectomy, the surgeon must connect the esophagus directly to the small intestine since there is no stomach remaining to serve as a connection point^[4].

Preparing for Gastrectomy Surgery

Before surgery, patients typically attend a pre-assessment appointment where medical staff evaluate overall health and fitness for the operation. During this visit, you will be asked about your medical history, current medications, and any supplements you are taking. Healthcare providers will perform routine tests such as blood work, an electrocardiogram to check heart function, chest X-rays, and lung function tests. It is important to bring all medications, tablets, and inhalers to this appointment^[4].

Lifestyle changes before surgery can significantly improve outcomes. If you smoke or use tobacco products, you must stop several weeks before surgery and avoid starting again afterward. Research shows that quitting smoking improves surgery outcomes in people with stomach cancer. Your healthcare provider may also recommend changes to diet and exercise to get in the best physical condition possible before the operation^[10].

Some medications need to be adjusted before surgery. You may need to temporarily stop taking blood thinners, including over-the-counter medicines like aspirin and ibuprofen, as well as supplements such as vitamin E. Many prescription medications also thin the blood. Your surgeon will provide specific instructions about which medications to continue and which to stop^[4].

Patients are usually admitted to the hospital the day before surgery. On the day of the procedure, you will not be allowed to eat or drink anything for four to six hours beforehand. Healthcare providers will apply special stockings to your legs to help prevent blood clots called deep vein thrombosis. You may also receive a small injection under the skin to further reduce the risk of clotting^[4].

Recovery and Hospital Stay

After gastrectomy, patients typically stay in the hospital for six to ten days. During the first few days after surgery, a tube may be placed through the nose to help keep the stomach area empty. This tube is removed once the bowels begin working normally again. Most people experience pain after the operation, and the medical team will provide medications to manage discomfort. It is important to tell your healthcare providers if pain is not adequately controlled^[4].

For the first few days, you will not be able to eat any food. Instead, nutrition will be provided through an intravenous line in your vein or a feeding tube placed into your belly. After about a week, you will begin a clear liquid diet, giving your digestive tract time to heal. Once you tolerate liquids well, you can gradually progress to a light diet and eventually solid foods over the next two to six weeks^[6].

Walking is extremely important during recovery, even though you may feel tired. Getting up and moving helps wake up your body’s systems, speeds recovery, prevents pneumonia and constipation, and improves blood flow to reduce the risk of blood clots. Start by walking short distances and gradually increase the amount each day^[4].

It usually takes six to eight weeks to fully heal from gastrectomy and return to usual activities, though complete recovery can take up to a year. When you first go home, you will need help with household tasks until you can perform them yourself. Avoid heavy lifting for at least six weeks after surgery. Most people can return to work between two and four months after the operation, depending on the type of work they do^[22].

Changes to Eating and Digestion

After gastrectomy, the digestive system works very differently, requiring significant changes to eating habits for the rest of your life. Because your stomach is smaller or absent, it can no longer hold regular portions of food. Right after surgery, you will feel full after only a few bites of food, approximately one to two ounces at a time, which is about the amount that fills a small glass. As your body adapts over six to twelve months, you will gradually be able to eat larger amounts, typically reaching child-sized meal portions^[20].

Without a stomach, your body cannot grind food, cannot digest and absorb every nutrient effectively, and will not send the same hunger signals to tell you when to eat. To compensate for these changes, you must eat smaller meals more frequently, aiming for six to eight small meals throughout the day. Chewing food very thoroughly becomes essential because the stomach is no longer available to grind food into smaller pieces. Eating slowly and taking twenty to thirty minutes for each meal helps with digestion^[20].

Drinking habits must also change after gastrectomy. It is important to avoid drinking large amounts of fluids with meals, as this can cause feelings of fullness before consuming enough calories and nutrients. Instead, drink fluids one hour before or after meals. Avoid carbonated beverages like soda, and do not use straws, as these can cause you to swallow excess air^[6].

Certain foods may need to be limited or avoided, particularly in the early recovery period. High-fiber foods like beans, lentils, and whole grains can fill you up too quickly, so add them back slowly. Crusty breads, bagels, tough meats, raw vegetables, nuts and seeds may be difficult to chew or digest. Many people develop difficulty digesting lactose, the sugar in milk, leading to gas, bloating, and diarrhea after consuming dairy products. Your dietitian will help you identify which foods work best for your body^[6].

Complications and Side Effects

Weight loss is expected after gastrectomy and happens fastest in the first month after surgery. This includes loss of both fat tissue and muscle mass. Because your body cannot absorb everything you eat and you feel full quickly, consuming enough calories becomes challenging. It is harder to regain weight after gastrectomy than it is for people with intact stomachs. Working with a dietitian helps prevent losing weight too quickly or losing too much muscle mass^[20].

Dumping syndrome is a common problem after gastrectomy, occurring when food moves too quickly from the remaining stomach or esophagus into the small intestine. This rapid movement can cause nausea, diarrhea, sweating, flushing, dizziness, shakiness, and abdominal cramps. To prevent dumping syndrome, avoid high-sugar foods that trigger symptoms, include protein and healthy fats in meals to slow digestion, and eat slowly^[5].

Vitamin and mineral deficiencies commonly develop after gastrectomy because the stomach and upper small intestine contain special proteins and enzymes needed for nutrient absorption. Without these, the body struggles to absorb certain vitamins and minerals. People who have had gastrectomy are at particular risk for deficiencies in vitamin B12, iron, calcium, and vitamin D. Regular blood tests help monitor nutrient levels, and most patients require vitamin supplements or injections for life^[7].

The way the body absorbs medications also changes after gastrectomy. Bypassing the stomach and upper small intestine reduces the time and surface area available for drug absorption. Some medications may be absorbed more quickly, leading to stronger effects, while others may not be absorbed well enough to work properly. Patients should work with a clinical pharmacist to review all medications after surgery. Extended-release medications and those requiring high acidity for absorption may need to be replaced with alternative forms^[13].

Surgical risks include infection at the incision site or inside the body, bleeding, reactions to anesthesia, blood clots, and damage to nearby organs. Specific complications related to gastrectomy include leaking from the connection points in the digestive system, narrowing of these connections causing blockages, and development of an incisional hernia where tissue pushes through weakened muscle in the belly wall^[5].

Long-Term Life After Gastrectomy

Living without a stomach or with a partial stomach should not prevent you from leading a full and active life, though it requires permanent lifestyle adjustments. Many people find that their desire to eat and enjoy food eventually returns, though it takes time to adapt to the changes. Learning to recognize your body’s new hunger cues is important, as these may include feeling tired, weak, dizzy, or lightheaded rather than traditional stomach hunger^[12].

Maintaining proper nutrition becomes a lifelong priority. Even when you do not feel hungry, eating on a regular schedule is essential because nutrition is vital for health. Setting timers or other reminders to eat throughout the day helps ensure adequate calorie and nutrient intake. Some people find it easier to eat while relaxed and distracted, such as watching television, reading, or playing games during meals^[20].

The changes to digestion and nutrient absorption mean that staying upright for some time after eating may be recommended by your doctor or nutritionist. Bowel movements may become irregular immediately after surgery, which is common. Taking a fiber supplement daily helps prevent constipation, though you should avoid straining during bowel movements. If you have not had a bowel movement after a couple of days, talk to your doctor about taking a mild laxative^[25].

Regular follow-up care with your healthcare team is essential for monitoring your health after gastrectomy. This includes checking for nutritional deficiencies, monitoring weight, assessing how well you are tolerating foods, and screening for any complications. Working with a dietitian long-term helps optimize nutrition and manage any eating challenges that develop^[20].