Gastrectomy, total; with formation of intestinal pouch, any type
CPT4 code
Name of the Procedure:
Total Gastrectomy with Formation of Intestinal Pouch
Summary
A total gastrectomy involves the surgical removal of the entire stomach. In this procedure, an intestinal pouch is created from the small intestine to take over some of the stomach's functions, aiding in digestion and nutrient absorption.
Purpose
This procedure is typically performed to treat stomach cancer, severe peptic ulcers, or other serious conditions affecting the stomach. The goal is to remove diseased tissue and reestablish a functioning digestive system using the newly formed intestinal pouch.
Indications
- Stomach cancer (gastric carcinoma)
- Severe peptic ulcers unresponsive to other treatments
- Non-cancerous tumors or polyps
- Genetic conditions like familial adenomatous polyposis (FAP)
- Chronic gastritis or other severe stomach diseases
Preparation
- Fasting for at least 8-12 hours before the procedure
- Discontinuation of certain medications as advised by the doctor
- Blood tests, imaging studies, and other assessments to evaluate health status
- Preoperative consultations with the surgical team and anesthesiologist
Procedure Description
- Anesthesia: General anesthesia is administered to the patient.
- Incision: A surgical incision is made in the abdomen.
- Stomach Removal: The entire stomach is carefully removed.
- Formation of Intestinal Pouch: A segment of the small intestine is fashioned into a pouch.
- Reconnection: The intestinal pouch is connected to the esophagus and the remaining portion of the small intestine.
- Closure: The incision is closed with sutures or staples.
Specialized surgical tools, endoscopic instruments, and sometimes robotic assistance are used during the procedure.
Duration
The surgery typically takes 4-6 hours.
Setting
This procedure is performed in a hospital's surgical suite.
Personnel
- Surgeon
- Surgical nurses
- Anesthesiologist
- Operating room technicians
- Postoperative care team
Risks and Complications
- Common risks: Infection, bleeding, blood clots, adverse reactions to anesthesia
- Possible complications: Leakage from surgical connections, nutritional deficiencies, bowel obstruction, dumping syndrome
- Management: Close monitoring, medications, and possible follow-up surgeries.
Benefits
- Removal of diseased or cancerous tissue
- Prevention of disease spread
- Potentially curative in cases of localized cancer Benefits are typically realized within weeks to months as the patient recovers.
Recovery
- Hospital stay of 1-2 weeks
- Initial nutritional support via intravenous (IV) or feeding tubes
- Gradual transition to small, frequent meals
- Regular follow-up appointments
- Recovery time varies but generally spans several months
- Activity restrictions to avoid strenuous activities initially
Alternatives
- Partial gastrectomy: Only part of the stomach is removed
- Chemotherapy and radiation: Non-surgical options for cancer treatment
- Endoscopic resections: Minimally invasive removal of tumors or polyps
- Pros and Cons: Alternatives might be less invasive but may not be as effective for extensive disease.
Patient Experience
- During Procedure: General anesthesia ensures no pain is felt during the surgery.
- After Procedure: Discomfort and pain management with medications, initial feelings of weakness or fatigue, gradual improvement of symptoms, and adjusting to new dietary habits.
- Pain management involves prescribed painkillers and comfort measures provided by the healthcare team.