Gastrectomy Surgery

Gastrectomy is a surgical procedure where part or all of the stomach is removed. This surgery is typically performed to treat stomach cancer, severe peptic ulcers, non-cancerous tumors, or other conditions that affect the stomach’s function. The surgery can be life-saving and significantly improve the quality of life for patients suffering from debilitating stomach issues.

Types of Gastrectomy

There are several types of gastrectomy, depending on the part of the stomach that is removed:

• Partial Gastrectomy: This involves removing only a portion of the stomach. It is often used to treat ulcers and tumors that are located in a specific part of the stomach.
• Total Gastrectomy: This involves removing the entire stomach. The esophagus is then connected directly to the small intestine. This is typically used for treating widespread stomach cancer.
• Sleeve Gastrectomy: This involves removing a large portion of the stomach, leaving a tube-like structure. This procedure is commonly used for weight loss surgery.
• Esophagogastrectomy: This involves removing the upper part of the stomach along with a portion of the esophagus. It is used to treat cancers at the junction of the stomach and esophagus.

Indications for Gastrectomy

Gastrectomy is indicated for a variety of conditions, including:

• Stomach Cancer: One of the most common reasons for gastrectomy. It is performed to remove the cancerous tissues and prevent the spread of cancer.
• Severe Peptic Ulcers: These ulcers can cause severe pain, bleeding, and perforation, which may require surgical intervention.
• Non-Cancerous Tumors: Tumors like gastrointestinal stromal tumors (GISTs) may necessitate gastrectomy.
• Obesity: Sleeve gastrectomy is a popular weight loss surgery for individuals with severe obesity.

Surgical Procedure

Gastrectomy can be performed using different surgical techniques:

• Open Surgery: A large incision is made in the abdomen to access the stomach.
• Laparoscopic Surgery: Several small incisions are made, and a laparoscope (a thin tube with a camera) is used to guide the surgery. This method is less invasive and has a quicker recovery time.

The choice of technique depends on the patient’s condition, the surgeon’s expertise, and the location and extent of the disease.

Preoperative Preparation

Before undergoing gastrectomy, patients typically undergo a series of evaluations and preparations:

• Medical Evaluation: This includes blood tests, imaging studies (such as CT scans), and endoscopy to assess the extent of the disease.
• Nutritional Assessment: Patients may need to meet with a dietitian to discuss nutritional needs and adjustments after surgery.
• Smoking Cessation: Smoking can impair healing, so patients are advised to quit smoking before surgery.
• Medications: Certain medications may need to be stopped or adjusted before surgery.

Postoperative Care

After gastrectomy, patients require careful postoperative care to ensure a smooth recovery:

• Hospital Stay: Patients typically stay in the hospital for about a week, depending on the extent of the surgery and their overall health.
• Pain Management: Pain relief is provided through medications. Pain control is crucial for recovery and mobility.
• Nutritional Support: Initially, patients may need to be fed through a tube. Gradually, they can start eating small, frequent meals. A dietitian’s guidance is essential for managing dietary changes.
• Physical Activity: Gentle physical activity is encouraged to prevent complications such as blood clots. Walking and breathing exercises are often recommended.

Potential Complications

As with any surgery, gastrectomy carries potential risks and complications:

• Infection: There is a risk of infection at the incision site or within the abdomen.
• Bleeding: Significant bleeding can occur during or after surgery.
• Dumping Syndrome: This occurs when food moves too quickly from the stomach to the small intestine, causing symptoms like nausea, vomiting, and diarrhea.
• Nutritional Deficiencies: Without a stomach, the body may have difficulty absorbing certain nutrients, leading to deficiencies.
• Bowel Obstruction: Scar tissue may form and cause blockages in the intestines.

Long-Term Outcomes

The long-term outcomes of gastrectomy largely depend on the underlying condition being treated and the extent of the surgery:

• Stomach Cancer: For stomach cancer, the prognosis depends on the stage of the cancer at the time of surgery. Early-stage cancers generally have better outcomes.
• Peptic Ulcers and Non-Cancerous Tumors: For these conditions, gastrectomy can often provide a permanent cure, significantly improving the patient’s quality of life.
• Obesity: Sleeve gastrectomy for obesity can result in significant weight loss and improvement in obesity-related conditions such as diabetes and hypertension.

Patients may need lifelong follow-up care to monitor for complications and manage nutritional needs.

Nursing Care of Patients with Gastrectomy

Gastrectomy, the surgical removal of part or all of the stomach is a major procedure that requires comprehensive nursing care to ensure optimal recovery and long-term health outcomes. Patients undergoing gastrectomy may have various underlying conditions, such as stomach cancer, peptic ulcers, non-cancerous tumors, or obesity. The nursing care plan for these patients should address the immediate postoperative needs as well as long-term management to prevent complications and support nutritional health.

Preoperative Care

Assessment and Education

Before surgery, nurses play a crucial role in assessing the patient’s overall health, understanding the underlying condition, and preparing the patient for the procedure. Key components of preoperative care include:

• Conducting a thorough health assessment, including medical history, medications, and allergies.
• Providing detailed information about the surgery, including the procedure, risks, and expected outcomes.
• Discussing the importance of postoperative care and potential lifestyle changes.
• Ensuring the patient understands preoperative instructions, such as fasting requirements and medication adjustments.

Immediate Postoperative Care

Pain Management

Effective pain management is essential to promote healing and comfort in the immediate postoperative period. Nurses should:

• Regularly assess the patient’s pain levels using appropriate pain scales.
• Administer prescribed analgesics and monitor their effectiveness.
• Provide non-pharmacological pain relief methods, such as positioning, relaxation techniques, and cold/heat applications.

Monitoring and Managing Complications

Postoperative complications can arise, and nurses must be vigilant in monitoring for signs and symptoms of potential issues. Key complications to watch for include:

• Bleeding: Monitor vital signs, wound sites, and drainage for signs of significant bleeding.
• Dumping Syndrome: Educate the patient about the symptoms of dumping syndrome and provide dietary recommendations to manage it.
• Nutritional Deficiencies: Monitor laboratory results for nutrient levels and collaborate with dietitians to ensure adequate nutrition.
• Bowel Obstruction: Assess for symptoms of bowel obstruction, such as abdominal pain, distention, and changes in bowel movements.

Wound Care

Proper wound care is critical for preventing infections and promoting healing. Nurses should:

• Inspect surgical incisions regularly for signs of infection, such as redness, swelling, or discharge.
• Follow protocols for dressing changes and wound care.
• Educate the patient on how to care for their wound at home.

Long-Term Management

Nutritional Support

Patients who have undergone gastrectomy may face challenges with nutrient absorption and maintaining a balanced diet. Long-term nutritional support includes:

• Working with dietitians to develop individualized meal plans that meet the patient’s nutritional needs.
• Educating the patient on the importance of small, frequent meals and avoiding foods that may trigger dumping syndrome.
• Monitoring for signs of malnutrition and addressing deficiencies through supplements or dietary adjustments.

Lifelong Follow-Up Care

Ongoing follow-up care is essential to monitor for complications and ensure the patient’s long-term health. Key elements of follow-up care include:

• Regular medical check-ups to assess the patient’s overall health and address any new symptoms or concerns.
• Laboratory tests to monitor nutrient levels and adjust supplementation as needed.
• Screening for potential recurrence of underlying conditions, such as cancer, if applicable.

Patient Education and Support

Empowering patients with knowledge and support can significantly improve their quality of life post-gastrectomy. Nurses should:

• Provide comprehensive education on lifestyle changes, including dietary modifications and physical activity recommendations.
• Offer emotional support and resources for coping with the physical and psychological impacts of gastrectomy.
• Encourage patients to join support groups or seek counseling if needed.

REFERENCES

1. Kang KM, Cho YS, Min SH, et al. Internal hernia after gastrectomy for gastric cancer in minimally invasive surgery era. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6694080/). Gastric Cancer. 2019;22(5):1009-1015.
2. Kosuga T, Tsujiura M, Nakashima S, Masuyama M, Otsuji E. Current status of function-preserving gastrectomy for gastric cancer. https://pubmed.ncbi.nlm.nih.gov/34095717/). Ann Gastroenterol Surg. 2021;5(3):278-286. Published 2021 Jan 27.
3. Marsh AM, Buicko JL. Gastric resection (https://www.ncbi.nlm.nih.gov/books/NBK560760/). [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
4. Medicover Hospitals, Gastrectomy: Procedure, Indications and Recovery. https://www.medicoverhospitals.in/procedures/gastrectomy/
5. Oh Y, Kim MS, Lee YT, Lee CM, Kim JH, Park S. Laparoscopic total gastrectomy as a valid procedure to treat gastric cancer option both in early and advanced stage: A systematic review and meta-analysis (https://pubmed.ncbi.nlm.nih.gov/31477462/). Eur J Surg Oncol. 2020;46(1):33-43.

Stories are the threads that bind us; through them, we understand each other, grow, and heal.

JOHN NOORD

Connect with “Nurses Lab Editorial Team”

I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.