Gastrectomy - a surgical treatment for diseases of the stomach and duodenum. resection principle consists in removing part of the stomach, followed by reduction of the integrity of the digestive tract due to gastrointestinal anastomosis (compound).
The method of resection depends on the location of the pathological process, type of disease ( cancer, stomach ulcer), excised body portion sizes.
The operation was performed in two main ways: Billroth I and Billroth II.
Gastrectomy in Assuta hospital - this is a sure way to select a treatment option.
Benefits of treatment in hospital are obvious:
- The high professionalism of medical staff - operation by the best experts in the claimed profile.
- Ability to choose your doctor - a significant bonus is practiced by the private Assuta medical complex.
- Advanced equipment that the clinic buys one of the first in the world.
Call us to find out more. We guarantee the official conclusion of the contract, reasonable prices for treatment.
Gastrectomy Billroth 1
Gastrectomy Billroth 1 - a circular excision of the antral and pyloric parts of the stomach, anastomosis between the stomach and the duodenum stump in an "end to end". Currently, Israeli surgeons use this method with a modification Gaberera II.
Benefits gastrectomy Billroth 1:
- It does not change the normal anatomy and function of the digestive system, as performed anastomosis of the stomach stump to the duodenum. It is conducive to the digestion of food falling from the stomach into the intestine, mixing with pancreatic, duodenal and biliary secretion. When resection Billroth 2 mixing process occurs in the jejunum. But in the absence of pyloric resection Billroth one passage of food from the stomach into the duodenum, jejunum and then carried out quickly. Therefore, mixing is actually performed in the jejunum. In this case, the differences are more theoretical in nature.
- Technically resection of the stomach by Billroth 1 to perform better. In addition, all surgical intervention is carried in the upper abdomen.
- Significantly less likely to develop dumping syndrome after surgery.
- This type of surgery does not increase the likelihood of developing internal hernias or afferent loop syndrome.
Disadvantages gastrectomy Billroth 1:
- This kind of operation often provokes the appearance of anastomotic ulcer, duodenal ulcer.
- Not in all cases it is possible to sufficiently mobilize duodenum 12 for forming an anastomosis with stomach to avoid tensioning the suture line. This causes duodenal ulcers, pronounced scar deformation and narrowing of the lumen of the gut, an ulcer of the proximal stomach. Some situations require the mobilization of the spleen and stomach stump, which leads to a complication of surgery and improve its unjustified risk.
- Gastrectomy Billroth 1 is not carried out in the diagnosis of gastric cancer.
Gastrectomy Billroth 2 characterized in that the stump sutured organ superimposed rear or front gastroenteroanastomosis. Billroth 2 also has a lot of modifications of suturing techniques jejunum to the stomach stump closure of the gastric stump, etc.
There is more evidence for resection Billroth 2: ulcer of the proximal, distal and middle thirds, peptic ulcer.
Benefits gastrectomy Billroth 2:
- An extensive resection body without strain gastrojejunal seams.
- In duodenal ulcer rarely occur after surgery peptic ulcer of anastomosis.
- When duodenal ulcer with gross pathological changes of duodenal stump suturing easier made than anastomosis with the stomach.
- When unresectable duodenal ulcers after resection "to turn off" for Finsterer-Bancroft-Plenk only by means of resection Billroth 2 manages to restore patency of the digestive system.
Disadvantages gastrectomy Billroth 2:
- It increases the risk of dumping syndrome.
- Possible, though rare complications are afferent loop syndrome and internal hernia.
Gastrectomy surgery: indications, types of surveys, equipment
there are absolute indications for gastrectomy:
- stomach cancer ;
- suspected malignancy ulcers;
- pyloric stenosis;
- recurrent gastrointestinal bleeding.
Relative indications for resection of the stomach - ulcer perforation, nonhealing ulcers.
Before surgical treatment a number of surveys conducted in the clinic Assuta: Upper endoscopy with biopsy, X-ray contrast examination, ultrasound, CT scan, blood tests for tumor markers, MRI, scintigraphy.
Used for pre-operative prophylaxis of metastasis and tumor growth stabilization of chemotherapy and radiation therapy.
equipment gastric resection for gastric cancer and peptic ulcer disease has its differences. If the diagnosis - a peptic ulcer, it removes 2/3 - 3/4 corpus with pyloric. In gastric cancer conducted a more extensive surgery to remove the large and small gland, the regional lymph nodes.
During surgery, a biopsy is done urgently, the results of the histological study, surgeons may decide to expand the operation.
When the location of the tumor in the cardia of the stomach with the spread of malignancy to the esophagus, Assuta Hospital surgeons perform the proximal resection of the stomach. Resected cardiac organ department with a part of the esophagus. The integrity of the digestive tube is reduced by crosslinking esophageal limb stump with the stomach.
The operation takes 120-240 minutes. Anesthesia - general anesthesia. Hospitalization - 10 - 14 days.
The next stages of complex treatment in Israel are radiotherapy and chemotherapy .
At advanced stages of gastric cancer resection is not performed. Appointed palliative treatment - chemotherapy, radiotherapy, immunotherapy.
Gastrectomy surgery clinic Assuta
This surgery is the most common and effective method of treating malignant tumors of the stomach.
Total removal of the body is performed at a large stomach tumor, the localization of the malignant process in the middle third of the body, while the prevalence of process of cancer recurrence. For more rare indications include stomach bleeding, ulcers, tumors, benign nature and a number of other diseases.
Gastrectomy surgery: why Israel Medicine
Gastrectomy is a severe and serious operation with a number of risks. According to statistics, in the early postoperative period, the mortality rate among patients is ten percent. The use of modern technology and operations by experienced surgeons vysokokvalifirovannymi improve prognosis. Assuta Hospital has to offer:
- professional services of the highest level with the knowledge of modern methods of performing gastrectomy;
- the latest diagnostic and treatment equipment;
- technology, minimally traumatic body, which reduces the period of convalescence.
Gastrectomy surgery is divided into 3 types:
- Distal subtotal gastrectomy, which removes part of the stomach adjacent to the intestines, and possibly a segment of duodenum.
- Proximal subtotal gastrectomy involves removing a small curvature of the stomach, small and large gland, gastrointestinal pancreatic ligament with a group of regional lymph nodes.
- Total gastrectomy is an operation in which the stomach is completely removed. The esophagus was ligated to the small intestine.
Preparation for surgery gastrectomy
The scan range may include the following procedures:
- Laboratory tests (blood tests, fecal occult blood).
- Endoscopic diagnosis by a flexible probe.
- Computed tomography, or PET-CT.
- X-ray examination of the gastrointestinal tract with barium suspension.
The preparation process includes advice on a special diet for receiving drugs.
Contraindications to gastrectomy: distant metastasis of cancer, a heavy patient's condition associated with cardiac, renal or respiratory failure, impaired blood clotting.
Gastrectomy: move operation
During this operation, the patient is under general anesthesia. The operation is performed abdominal or combined access.
In the propagation of cancer of the stomach to the esophagus Assuta Hospital surgeons use a combination of access: a left lateral thoracotomy combined with a laparotomy.
In infiltrative tumor growth, undifferentiated tumors, the total defeat of gastric cancer with regional metastasis, laparotomy is used - abdominal access.
Gastrectomy is performed in compliance with the rules of ablation. At the initial stage, revision of the abdominal cavity. When the location of a malignant tumor in the upper and middle parts of the stomach to the esophagus with invasion, revealed left pleural cavity and intersects the diaphragm. Removal of the stomach is performed en bloc small and large glands, fat tissue, ligaments, regional lymph nodes, part of the esophagus. After cutting off the duodenum performed anastomosis between the esophagus stump and jejunum.
Also used during laparoscopic approach gastrectomy. It is much less traumatic for the patient. The disadvantage is the difficulty in removing the lymph nodes near the blood vessels and vital organs.
Endoscopic gastrectomy using the robot system da Vinci provides high accuracy, allowing to operate in hard to reach areas.
The postoperative period
Among the possible complications of note:
- preservation foci malignancy;
- damage to adjacent blood vessels;
- nutritional deficiencies;
- inability to take the normal quantity of food;
- dumping - syndrome (a condition in which ingestion can cause vomiting, nausea, diarrhea and sweating).
After surgery, gastrectomy patient may need the following care and medical support:
- When inability to take an adequate amount of fluid introduction is done intravenously.
- A nasogastric tube is introduced through the nose into the stomach (the stored portion thereof) to withdraw secrete digestive juices until it starts to function properly intestine.
- Catheter feeding injected into the small intestine before transition to ordinary food.
- Possible need for intravenous administration of antibiotics, in catheterization, in the application of the oxygen mask.
Power operation after gastrectomy
The diet will make the following changes must be:
- Reduce the size of servings.
- Increase the frequency of meals 5-6 times a day, chewing thoroughly and taking with a weak solution of citric acid. Three- and four meals leads to anemia and intestinal problems.
- Refrain from receiving large amounts of fatty food.
- In order to ensure a healthy diet need reception of biologically active additives.
Patients who have undergone stomach ektirpatsiyu (after 1-1.5 after surgery) recommend giponatrievuyu (low salt) diet that contains a large number of proteins, limited - fat and a very small amount of easily digestible carbohydrates. It is necessary to limit the mechanical and chemical irritants of the mucous membrane of the gastrointestinal tract: spices, pickles, chocolate, pickles, alcohol, canned foods, soft, hot and cold drinks. Basically, the diet should consist of cooked food or steamed.