World Library  
Flag as Inappropriate
Email this Article

Gastrectomy

Article Id: WHEBN0000797461
Reproduction Date:

Title: Gastrectomy  
Author: World Heritage Encyclopedia
Language: English
Subject: ICD-9-CM Volume 3, List of surgical procedures, Gastroenterostomy, Theodor Billroth, Roux-en-Y anastomosis
Collection: Digestive System Surgery
Publisher: World Heritage Encyclopedia
Publication
Date:
 

Gastrectomy

Gastrectomy
Intervention
Diagram of the stomach, showing the different regions.
ICD-9-CM 43.5-43.9
MeSH
MedlinePlus

A gastrectomy is a partial or full surgical removal of the stomach.

Contents

  • Indications 1
  • Polya's operation 2
  • Post-operative effects 3
  • History 4
  • See also 5
  • References 6

Indications

Gastrectomies are performed to treat cancer and perforations of the stomach wall.

In severe duodenal ulcers it may be necessary to remove the lower portion of the stomach called the pylorus and the upper portion of the small intestine called the duodenum. If there is a sufficient portion of the upper duodenum remaining a gastroduodenostomy is performed, where the remaining portion of the stomach is reattached to the duodenum before the bile duct and the duct of the pancreas. If the stomach cannot be reattached to the duodenum a gastrojejunostomy is performed, where the remaining portion of the duodenum is sealed off, a hole is cut into the next section of the small intestine called the jejunum and the stomach is reattached at this hole. As the pylorus is used to grind food and slowly release the food into the small intestine, removal of the pylorus can cause food to move into the small intestine faster than normal, leading to gastric dumping syndrome.

Polya's operation

A type of posterior gastroenterostomy which is a modification of the Billroth II operation. Resection of 2/3 of the stomach with blind closure of the duodenal stump and retrocolic anastomosis of the full circumference of the open stomach to jejunum.

Post-operative effects

The most obvious effect of the removal of the stomach is the loss of a storage place for food while it is being digested. Since only a small amount of food can be allowed into the small intestine at a time, the patient will have to eat small amounts of food regularly in order to prevent gastric dumping syndrome.

Another major effect is the loss of the intrinsic-factor-secreting parietal cells in the stomach lining. Intrinsic factor is essential for the uptake of vitamin B12 in the terminal ileum and without it the patient will suffer from a vitamin B12 deficiency. This can lead to a type of anemia known as megaloblastic anaemia (can also be caused by folate deficiency, or autoimmune disease where it is specifically known as pernicious anaemia) which severely reduces red-blood cell synthesis (known as erythropoiesis, as well as other haemotological cell lineages if severe enough but the red cell is the first to be affected). This can be treated by giving the patient direct injections of vitamin B12.

Another side effect is the loss of ghrelin production, which has been shown to be compensated after a while.[1]

History

The first successful gastrectomy was performed by Theodor Billroth in 1881 for cancer of the stomach.

Historically, gastrectomies were used to treat peptic ulcers.[2] These are now usually treated with antibiotics, as it was recognized that they are usually due to Helicobacter pylori.

In the past a gastrectomy for peptic ulcer disease was often accompanied by a vagotomy, to reduce acid production. Nowadays, this problem is managed with proton pump inhibitors.

See also

References

  1. ^ MASAYASU KOJIMA AND KENJI KANGAWA. Ghrelin: Structure and Function. Physiol Rev 85: 495–522, 2005. doi:10.1152/physrev.00012.2004.
  2. ^ E. Pólya:Zur Stumpfversorgung nach Magenresektion. Zentralblatt für Chirurgie, Leipzig, 1911, 38: 892-894.
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and USA.gov, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for USA.gov and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
 
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
 
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.
 


Copyright © World Library Foundation. All rights reserved. eBooks from Project Gutenberg are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.