Laparoscopic Gastrectomy


Laparoscopic Gastrectomy

What is Laparoscopic Gastrectomy Surgery?

A Gastrectomy is the surgical removal of all or part of the stomach.

The stomach is a muscular organ located on the left side of the upper abdomen and receives food from the esophagus. As food reaches the end of the esophagus, it enters the stomach through a muscular valve called the lower esophageal sphincter. The stomach secretes acid and enzymes that digest food.

Gastrectomy is performed for the following conditions:

  • Stomach Cancer
  • Bleeding Gastric Ulcers
  • Perforation (Hole) in the Stomach Wall
  • Benign Polyps

TYPES OF PROCEDURES

There are several approaches our surgeon can adopt to perform a Gastrectomy. His chosen procedure and technique depend on the condition he is treating:

  • Partial Gastrectomy is the removal of only part of the stomach. The remaining portion then continues with its digestive role.
  • Total Gastrectomy is when the entire stomach is removed; the esophagus is connected directly to the small intestine, where digestion now begins.  Patients must make significant dietary changes when a total Gastrectomy is performed.
  • Sleeve Gastrectomy is the removal of the left side of the stomach but does not involve any rearrangement of intestines. This can reduce your stomach's volume by up to 75%, and is usually performed using keyhole surgery. The remaining part of your stomach is pulled upwards and resealed using stitches. This creates a much smaller and longer stomach that looks like a banana.
  •  Esophagogastrectomy is used to remove the upper section of the stomach and part of the esophagus.The lower part of your stomach is pulled upwards and attached to the end of your esophagus.

A Billroth Procedure is performed for severe gastric ulcers involving the duodenum, the pylorus, the lower portion of the stomach, may be removed along with the all or part of the duodenum, the upper portion of the small intestine. It is a standard treatment for ulcer disease, stomach cancer, injury and other diseases of the stomach. This was first described by Theodor Billroth, the pioneer in modern surgery.

  • Billroth I & Billroth II
    • Billroth I is also called gastroduodenostomy. It involves the partial gastrectomy or removal of the antrum and pylorus of stomach) with anastomosis of the gastric stump to the duodenum.
    • Billroth II is also called gastrojejunostomy. It involves the partial gastrectomy or removal of the antrum and pylorus of stomach) with anastomosis of the gastric stump to the jejunum.

 

The Laparoscopic Gastrectomy Advantages

Results are different for each procedure and each patient. Some common advantages of Laparoscopic Gastrectomy surgery are:

  • Shorter hospital stay
  • Shorter recovery time
  • Less pain from the incisions
  • Faster return to normal diet
  • Faster return to work or normal activity
  • Better cosmetic healing

PREPARATION FOR SURGERY

 Before traveling to Cyprus, as part of your Gastrectomy surgery preparation you will complete a detailed bariatric specific questionnaire, which will allow our doctors to determine your eligibility for Gastrectomy surgery. If you are not ready to make lifestyle changes, you will not be considered eligible for the procedure.

Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.

After hospital admission, you will receive psychological advice. This will help you adhere to a healthier lifestyle. Without changing your lifestyle, the surgery will not be a success. You will also receive nutritional counseling before (and after) your surgery, by our specialists.

  

RECOVERY AFTER SURGERY

Following surgery, most patients make a full recovery within one month. You are able to return to work, resume some lifting and less strenuous activity, in most cases, in about two weeks post operatively.

Laparoscopic Gastrectomy is a restrictive procedure. It greatly reduces the size of your stomach and limits the amount of food that can be eaten at one time. After eating a small amount of food, you will feel full very quickly and continue to feel full for several hours. Laparoscopic Sleeve Gastrectomy may also cause a decrease in appetite.

Daily light exercise such as walking should begin about one month after surgery.

Following your recovery diet you will slowly begin to introduce new foods in increasing quantities until about 6 months after surgery when your new bariatric diet will be in full swing. All Gastrectomy procedures require a complete change in diet for your procedure to be considered successful.

Assuming you follow the diet and exercise guidelines of our surgical team, all indications are that your health improvement following the Gastrectomy surgery may be permanent.

 

LIFE AFTER SURGERY

These guidelines give you an overview of what you may expect as part of your
care after you leave the hospital. Be sure to follow your doctor’s discharge
instructions if they are different from what is listed here.

Post-Surgery Nutrition

After surgery, you will need a new nutrition plan. Our surgeon and/or dietitian can help you learn about and get used to the changes in lifestyle and eating habits you need to make. It is very important to follow the eating and drinking instructions beginning immediately after the operation.

In the first few weeks after your surgery, you will be on a liquid diet since only thin liquids will be tolerated by your stomach at that time. As you heal, you will gradually progress to pureed foods (three to four weeks post-op) and then soft foods (five weeks post-op). Finally, you will be able to eat solid foods.

When you are at the stage to eat solid foods without problems, you will need to pay close attention to your diet.

You will also need to learn to eat slowly and chew your food very thoroughly.

It is recommended that you eat only three small meals a day and make sure that these meals contain adequate nutrients. Foods that have a concentrated supply of calories with little nutritional value, such as milkshakes, syrups, jam, and pastries, should be avoided as much as possible.

Your Activity

 It is fairly common to feel weak and tired immediately after discharge from the hospital. The body needs time to recover from the stress of a major operation.

Exercise is very important and incorporating regular physical activity into your daily routine is as important as following your nutrition plan. Gastrectomy patients have been inactive due to decreased activity tolerance, psychological constraints and in some cases, physical disabilities. After Laparoscopic Gastrectomy aerobic activities, particularly walking and swimming are generally best tolerated. Your surgeon will advise you on which activity is right for you.

  • Walking is permitted and encouraged beginning the 2 day after surgery. At home, start short, daily walks and gradually increase the distance you walk.
  • Going up and down stairs is permitted. Initially, have someone assist you.
  • You may lift light objects (less than 10lbs.) after your discharge. This may be increased gradually after one month. If lifting an object causes discomfort, you should discontinue the activity. This restriction helps prevent hernias at the sites of your incisions.
  • Showers are permitted 4 days after surgery. Wash over your incisions gently with soap and water. Be careful to rinse well. Pat the incisions dry.
  • Driving is not permitted for 2 weeks after surgery or your first follow-up visit with your surgeon. If you are taking prescription pain medications or narcotics, DO NOT DRIVE.
  • Sexual intercourse may be resumed as your comfort level permits.
  • People with sedentary jobs have returned to work as early as two weeks postoperatively. A physically demanding job may require 8 weeks before returning to work. This may be determined by you and your employer. Some people have residual fatigue several weeks after surgery.

Your bowel habits

You may have different bowel habits after your surgery. Loose stools are common for the first week or two after surgery. If you have watery diarrhea, call your surgeon. This may be a sign of a bowel infection. Severe constipation should be avoided. See the section below on medicines for constipation.

Medications

Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.

For pain

Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.

For constipation

Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.

Call your surgeon right away if you have:

  • Diarrhea that lasts more than three days
  • Nausea and vomiting that will not go away
  • Pain in your abdomen that gets worse or isn’t eased by the pain medicine
  • Pus drainage or redness around your incision
  • Fever with a temperature of 100.5 or higher

FOLLOW-UP

Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.

 


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