Gastrectomy:

Gastrectomy is one of the most common surgical procedures in the world to fight obesity or stomach cancer.
This treatment is done by two methods, open and closed, or laparoscopy.

Gastrectomy is referred to as any treatment that results in complete or complete removal of the stomach.

Stomach anatomy:

The stomach is the most expanding part of the digestive system and resembles the letter J.

The stomach is between the esophagus and the small intestine

Gastrectomy

Another feature of the stomach is the presence of two curves:

1- The greater curvature, which starts from the left side of the esophagus with a depression called the cardiac fissure, rises up and to the left, then flows down and to the right. A large tent attached to this bend.

2. Less curve that starts from the right side of the esophagus without any protrusion, and continues the stomach stem until it ends in the pylorus area, and a small tent is connected to this curve.

The stomach is divided into four parts:

Cardia region:

That surrounds the esophageal opening

The bottom of the stomach:

The part located above the opening of the heart of the stomach

Stomach trunk:
You can also read the article (Breast prosthesis)

The biggest part is the stomach

Gate zone:

Which is divided into the Gare and Gate channel

The gastric outlet or pyloric hole on the surface of the stomach is identified by the pyloric depression and surrounded by a thick ring of the intestinal ring muscle called the pyloric sphincter, and the pyloric hole passes to the right of the midline and the lower edge of the L1 vertebra.

The other parts of the stomach are:

A large curvature of the stomach connects the gastro-splenic ligament and the omentum

The small curve of the stomach that connects the small omentum

Heart incision: the upper angle that the esophagus connects with the stomach

The left gastric artery from the abdominal trunk
The right gastric artery of the hepatic artery
The right gastro-intestinal artery of the duodenum
Left gastro-intestinal artery of the spleen
Posterior gastric artery of splenic artery

Types of gastrectomy:

Total gastrectomy: the complete removal of the stomach
Subtotal: resection of the end of the stomach

Partial gastrectomy is performed in two ways:

Belarus 1
Belarus 2

In Belarus, the end of the stomach and the pylorus are removed and an infectious duodenostomy is performed.

In Belarus, the end of the stomach and the pylorus are removed, a gastric jejunostomy is performed, which may be on or off the side, and the proximal end of the duodenum is closed.

Indications for gastrectomy:

Stomach cancers
Hemorrhagic gastric and duodenal ulcers are resistant to conservative treatment

Attention:

When receiving a patient, except in routine cases, pay attention to the following points:

Satisfaction with work

Blood reservation

Sufficient Laboratory Papers Including Hemoglobin – Hematocrit – INR-PT-PTT

If you have a biopsy or endoscopy, it should be on file

Reserve the ICU if needed

Required Items:

Gastric tube
Cutter and suction
Legashore
Cell saver, if available
60 and 80 linear shear staplers
Laparotomy essential kit and automatic abdominometry device
Stomach and intestinal cramps
Bestore 20 or 22
Zero and one silk to close the arteries
Three chromic or vicryl anastomosis, which is the first layer of the anastomosis
Silk with zero or three zeros for muscle and serum anastomosis, which is the dermal layer of the anastomosis
Nylon is a loop for the fascia
Double cut nylon for skin
Quilted gas
Sounding equipment
Depending on the surgeon’s routine, blood drains, tubular drainage, Bitzer or Caroget may be used.

Position: supine

Anesthesia: General

Birb: From Mead Chest to Pubis

Derb: Four of them are square

Description of the operation and method of surgery

Approach: midline or thoracic abdomen

Before the incision, a gastric tube is inserted into the patient by the anesthesia team

First, 20 or 22 lashes are opened under the skin with a small bar and, if necessary, the arterioles cut

Then Lina Alba and Britton are loaded with the dead or catheter and we enter the abdominal cavity and after a complete examination of the abdominal cavity we use an automatic control device and we detect it, then first the stomach and duodenum must be separated from their joints.

The vascular connections are made by ligaments, and if there is no ligament, the multiple sides of the artery are cut and cut between them using multiple twisted forceps and tied with a silk thread of zero or two according to the diameter of the narrow vessels, then the gastric colic ligament is released at the large bend of the stomach.

The duodenum, an extra-peritoneal organ, is then released by the Kocher maneuver, which involves firing the posterior peritoneum into the duodenum, between the duodenum, the colon, and the liver. We then proceed according to the type of gastrectomy. Including:

1. Cystectomy: The removal of the front part of the stomach which makes up about 30% of the stomach.

Gastrectomy: The removal of about 50% of the stomach.

3- Partial gastrectomy: It is the removal of about 90% of the stomach.

4- Total gastrectomy: It is the complete removal of the stomach.

The gastric tube is withdrawn by the anesthesia team to the top of the resection site and then the part near the stomach prepared for the ablation is fixed with a gastric clamp. Which usually uses 60 or 80 and does not require special work

However, if a stapler is not available and the excision is performed with anesthesia, the scrub places gas completely impregnated with betadine under the stomach and the site of the incision, then proceeds to cut the stomach so that if secretions come out, the gas can be absorbed.

For the portal we do the same (either with a stapler or a bistro) and remove the stomach and the pylorus, and for re-anastomosis, depending on the surgical procedure, we use either Belarut 1 or Belarot 2.

So:

We give duodenum to the rest of the stomach anastomosis

Belerot 2 closes the free end of the duodenum with vicryl or chromium

Two zeroes of mucus and two zeros of silk,  Two shadows and two strands, or by means of a stapler, we usually place the omentum patch on the stump of the duodenum and fix it with two silk sheets, and the rest of the stomach is anastomotic to the jejunum.

Gastric jejunostomy from end to side and ask the anesthesia team to send the stomach tube again to pass through the anastomosis site. After checking the location of the gastric tube, we wash the abdomen and count gases, limp, tools and if necessary drainage. Depending on the surgeon’s routine, usually we use caroget or tubular drainage, then we close the peritoneum without chrome and wrap with nylon, one ring and subcutaneous with chrome or vicryl at zero, and the skin with nylon two zero.

However, the peritoneum may not be sutured separately and the peritoneum may be fixed with a fascia with a ring. A skin stapler may also be used to close the skin, then the surgical site is bandaged with regular gauze and the patient is moved to recovery.

Total gastrectomy:

All stages are similar to a partial gastrectomy, only the type of anastomosis differs

Indications for total gastrectomy:

Stomach cancers
Polyps in the stomach
Stomach perforation
Ulcers

Stomach cancer is more common in men over the age of forty and sometimes in young adults. Most cancers are found in the small curve of the stomach and antrum and extending to the mucous membrane, stomach wall, and adjacent organs.

Causes of stomach cancer:

Chronic gastritis
Amiriyx anemia
No secretion of HCL
Ulcers
Genetic background
Helicobacter pylori

The early stages of cancer are usually asymptomatic, but in the later stages symptoms such as indigestion appear

Anorexia
Ascites
Weight loss
stomachache
Constipation
Anemia
Nausea and vomiting appear

Diagnosis:

CT scan
Swallow barium
Endoscopy
Get a biopsy
Anorexia
Ascites
Weight loss
stomachache
Constipation
Anemia
Nausea and vomiting appear

Treatment measures include:

– Chemotherapy
Radiation therapy and surgery

In total, the stomach is removed completely and the esophagus is anastomotic to the jejunum. The Roux-en-Y method is used to remove the stomach from the abdominal cavity (such as a tumor in the lower part of the stomach).

In this method, the jejunum is cut and its proximal head is tied to the stomach, and the distal head of the jejunum is opened at some point, and the stomach does not come out of the abdomen.