Gastrectomy, total; with Roux-en-Y reconstruction
CPT4 code
Gastrectomy, Total; with Roux-en-Y Reconstruction
Name of the Procedure:
Total Gastrectomy with Roux-en-Y Reconstruction; also known as Total Stomach Removal with Roux-en-Y Bypass
Summary
Total gastrectomy with Roux-en-Y reconstruction is a surgical procedure that involves the complete removal of the stomach. The digestive system is then reconstructed using the Roux-en-Y technique, where a portion of the small intestine is redirected to functionally replace the stomach.
Purpose
The procedure addresses conditions such as stomach cancer, severe peptic ulcer disease, and certain genetic conditions like familial adenomatous polyposis. The main goal is to remove the diseased stomach to prevent the spread of cancer or alleviate severe symptoms, enabling the patient to have a functional digestive system.
Indications
- Stomach cancer
- Severe or refractory peptic ulcer disease
- Gastric polyps with high malignant potential
- Familial adenomatous polyposis (FAP)
- Zollinger-Ellison syndrome not responsive to medication
Preparation
Patients are generally instructed to:
- Fast for at least 8 hours before surgery.
- Adjust or stop certain medications, as advised by the doctor.
- Undergo diagnostic tests such as endoscopy, CT scans, and blood tests.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: An incision is made in the abdomen to access the stomach.
- Stomach Removal: The entire stomach is carefully removed.
- Reconstruction: The Roux-en-Y technique is used to create a new pathway. The esophagus is connected to a segment of the small intestine (jejunum), forming a 'Y' shape that bypasses the stomach.
- Closure: The incision is closed with sutures or staples.
The procedure uses surgical tools such as scalpels, laparoscopic instruments, and staplers.
Duration
The procedure typically takes 4 to 6 hours.
Setting
It is performed in a hospital operating room.
Personnel
- Surgeons
- Surgical nurses
- Anesthesiologists
Risks and Complications
- Common: Infection, bleeding, blood clots, nutritional deficiencies.
- Rare: Anastomotic leak, internal hernias, chronic diarrhea.
Management often involves antibiotics, nutritional support, and sometimes further surgery.
Benefits
- Removal of malignant or diseased tissue.
- Relief from severe symptoms.
- Potentially life-saving in cases of cancer.
Benefits can be realized soon after recovery, though full nutritional adjustment may take time.
Recovery
- Hospital stay of 7 to 10 days.
- Gradual reintroduction to a soft or liquid diet.
- Regular follow-up appointments for nutritional assessment and monitoring.
- Avoid heavy lifting or strenuous activity for several weeks.
Alternatives
- Partial gastrectomy: Only part of the stomach is removed.
- Endoscopic treatments: Less invasive, suitable for early-stage lesions.
- Chemotherapy or radiotherapy: Depending on the cancer stage, can be used alone or as adjuvant therapy.
Each alternative has its pros and cons related to invasiveness, recovery time, and effectiveness.
Patient Experience
Patients may experience discomfort and pain post-surgery, managed with medication. They might feel weakness or fatigue during the initial recovery period. Nutritional adjustments are crucial, with vitamin and mineral supplements often necessary long-term for maintaining health.