In most cases, in the treatment of pathologies of the gastrointestinal tract, conservative therapy is used. When it is ineffective or time is lost, doctors recommend surgery. The article discusses what gastric 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.
Procedure description
Resection of the stomach is called an operative method for the treatment of diseases of the gastrointestinal tract. It is the removal of a part of the affected organ and its subsequent restoration by applying an anastomosis. If, according to indications, the complete removal of the stomach is required, then the operation will be called a total gastrectomy.
Reviews of stomach resection say that the operation is quite effective, and the wide possibilities of its execution allow finding an individual approach to each patient.
The first such intervention was carried out in 1881. Theodor Billroth became the founder, one of the resection methods is named after him, whichactively used today.
The operation is performed under endotracheal anesthesia. She can be:
- Sparing, 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 with the esophagus.
Undoubtedly, the operation is a traumatic method of treatment and is prescribed only in extreme cases, but sometimes only it can prolong the life of the patient.
Indications for intervention
Resection of the stomach cavity is performed in the treatment of such diseases:
- Obesity or overweight problems. Such pathologies are increasingly common in the practice of surgeons; it is not uncommon for an operative method of treatment to be the most effective. The price of stomach resection for weight loss varies within 150 thousand rubles.
- Cancer. If malignant neoplasms are found 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 ulcers that are caused by the digestive process. Also, the surgical method of treatment is recommended for patients in whom the ulcer passes to other organs and provokes bleeding.
- Narrowing the gatekeeper. An operation with this diagnosis is prescribed in the case of a decompensated type of disease, the symptoms of which are similar to peptic ulcer disease.
Contraindications
The operation is carried out only in extreme cases and is consideredlast resort treatment. But it also has contraindications.
It is forbidden to perform gastrectomy in such cases:
- Localization of multiple metastases in nearby organs. If the tumor spreads beyond the stomach, the operation is considered ineffective and carries more risk to the patient's life than benefit.
- In the accumulation of free fluid around the 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.
- When the body is exhausted, when weight loss is pathological.
Types of surgery
Modern surgery has several methods of resection in its arsenal. Ample opportunities allow you to choose an individual method of treatment for each patient.
Based on the examination, tests and examination, the doctor chooses the type of gastric resection.
Depending on the volume of the removed part of the stomach, operations are divided into:
- Economic resection. In this case, 1/3 to 1/2 of the organ is removed.
- Extensive resection. It is also called typical. During the operation, approximately 2/3 of the organ is removed.
- Subtotal resection, when it is necessary to cut out 4/5 of the volume of the organ.
- Total resection. With such an operation, about 90% of the organ is removed.
Depending on the partof the stomach, on which the operation is planned, there are such types of operations:
- Distal resection - removal of the lower part of the stomach.
- Proximal resection - removal of the cardia and inlet 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 to be performed after the operation, two methods of resection are used:
- 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 low intestinal motility and is rarely used.
- Resection according to Billroth II is the suturing of the stump of the digestive organ in the side of the duodenum.
All Billroth operations have many modifications that surgeons successfully apply in practice.
Resection for ulcer or cancer
Gastric resection surgery is considered the only treatment option for early-stage cancer or advanced gastric ulcers. Let's consider each problem in more detail.
Organ ulcer
When a diagnosis of "gastric ulcer" is established, surgeons suggest cutting out part of the organ to avoid recurrence. Usually 60 to 75% of tissue is resected.
The operation is performed with the removal of the antrum and pylorus. The first produces a special hormone - 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 stomach acid. The rest are recommended organ-preserving interventions.
Stomach cancer
If the diagnosis of "malignant tumor" is confirmed, then surgeons perform subtotal or total resection. This approach is effective in preventing relapse.
During the operation, part of the greater and lesser omentum, lymph nodes located near the stomach are cut out. If during the intervention the growth of metastases in adjacent tissues is detected, then a combined resection is performed - the tissues of the stomach are removed along with formations in the esophagus, liver or intestines.
Longitudinal resection of the stomach
This operation is also referred to as "drain", vertical or sleeve resection. It is the removal of the lateral part of the digestive organ, which significantly reduces its volume. It is this method of treatment that is becoming the most popular for overweight patients.
Specific 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 digestion process.
- Due to the longitudinal resection of the stomach, a person cannot eat a large portion of food, which leads to faster saturation of the body. As a result of eating smaller portions, excess weight is rapidly lost.
- During the operation, a part of the stomach is removed, in which the hormone ghrelin is produced, which is responsible for a person's feeling of hunger. When it decreases in the blood, 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 laparoscopically using a special apparatus.
Laparoscopic gastrectomy
This operation is performed using a laparoscope. Its feature is minimal trauma and a shorter rehabilitation period. Several small incisions are made on the patient's body, into which the device and instruments for the operation are inserted. To remove the stomach with this method, an incision of only 3 cm is required.
Laparoscopic surgery has the following advantages over open surgery:
- less pain;
- mild postoperative period;
- significantly lower number of postoperative complications;
- more cosmetically 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 stomach resection by this method is up to 200 thousand rubles.
Laparoscopic method is recommended for complications of peptic ulcer, when anti-ulcer drugs are ineffective. In the presence of malignant tumors, the method is not applied.
How to prepare for surgery?
Usually, such operations are carried out in a planned manner. To know all the nuances and prepare, the doctor prescribes examinations:
- Urine analysis general.
- Blood test (general, group and biochemistry).
- Blood clotting test.
- Fibrogastroduodenoscopy.
- Electrocardiogram to assess the condition of the heart.
- X-ray of lungs.
- Ultrasound of the abdominal organs.
- Therapist is being examined.
If a patient is admitted with internal bleeding or a perforated ulcer, then surgeons decide on an emergency resection.
It is mandatory to clean the body with an enema before the operation. The price of stomach resection for weight loss is up to 150 thousand rubles.
The operation lasts about 3 hours and is performed under general anesthesia.
Intervention steps
Resection of the stomach is carried out according to the following plan:
- A revision 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.
- The necessary share of the digestive organ is being resected.
- Anastomosis of the stump of the stomach and intestines is being created.
- After all the manipulations, the wound is sutured and drainage is installed.
Consequences
Despite the cost of gastric resection for weight loss and many positive reviews about this operation, the patient may face complications. The surgeon must notify the person of all risks prior to surgery.intervention.
Dumping syndrome or failure syndrome.
In the postoperative period, patients report the following symptoms: palpitations, dizziness, nausea and vomiting, weakness. In some cases, neurotic symptoms appear.
This complication occurs due to the fact that after resection, the food does not undergo the necessary processing in the stomach, but enters the intestine unchanged. Food interferes with fluid absorption and leads to complications.
There are three stages in the development of complications:
- Mild - manifested by rare attacks.
- Medium - manifested by increased blood pressure, tachycardia, nausea.
- Severe - regular seizures occur, loss of consciousness and metabolism may occur.
Mild and moderate degrees are amenable to conservative treatment with dietary adjustments, and the third stage involves only surgery.
Anastomosis is a complication that manifests itself as an inflammatory process at the site of the anastomosis. This causes pain, vomiting, nausea. If the pathology is not treated in time, the stomach begins to deform and re-intervention is required.
Gastric resection for weight loss or medical reasons may have consequences not only in the long term. Among the complications of the early postoperative period can be noted:
- appearance of bleeding;
- possible wound infection;
- peritonitis;
- shock patient;
- thrombophlebitis.
Nutrition after surgery
Resection of the stomach for weight loss or for medical reasons requires following a diet in the postoperative period. Meals should be taken in small portions several times a day.
Immediately after the operation, the patient is given solutions for parenteral nutrition, since it is impossible to eat in the usual way. After a couple of days, the use of compotes, tea, decoctions is allowed. Infant formula is administered to the patient using a feeding tube.
Within two weeks, the diet expands and after the expiration of the period, the patient can eat on his own on a sparing diet.
In the postoperative period recommended:
- Eat mostly purees and soups based on vegetables or grains.
- Steam, oven or boil.
- Eat lean meats, preferably poultry.
- Fish should also not be oily - you can eat bream, hake, cod, pike perch.
- You can eat peeled apples and mashed vegetables.
Do not use or limit:
- Exclude fried foods, canned foods, smoked foods, carbonated drinks.
- No baked goods for the first month after surgery. Further control consumption.
- Plant food with coarse structure.
- After two months after the operation, it is allowed to consume dairy products in limited quantities.
- Completely eliminate s alt from the diet.
Worth itremember that the volume of food should not exceed 150 ml per serving, the frequency of meals should be 5-6 times a day.
Cost of the procedure and reviews
The cost of gastric resection surgery can be carried out according to indications in any surgery department free of charge. But it is worth remembering that a qualified specialist and modern equipment are the key to a 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 about gastric resection are mostly positive. Patients note:
- The ability to get rid of problems with a single operation. If an ulcer or cancer is being operated on, then resection helps to defeat the disease.
- When obese people often turn to specialists for help. Due to excess weight, they are unable to play sports, and sometimes even move around. Such an operation helps them lose weight and get in shape.
- Laparoscopic surgery is a virtually painless procedure with few complications.
- Discomfort in the first months after surgery, as you have to eat a strict diet and adhere to strict rules.
- The main thing is to find a qualified specialist who not only wants to earn money, but strives to solve the patient's problems.
- Adhesion may occur.
It can be said that an operation is always a last resort. Butthere are cases when intervention is simply indispensable. Resection of the stomach is carried out only after a thorough examination, considering all the pros and cons.
