Gastrectomy, partial, distal; with Roux-en-Y reconstruction

CPT4 code

Name of the Procedure:

Summary

A partial gastrectomy involves surgical removal of the distal (lower) part of the stomach, typically followed by reconstructing the digestive tract using a Roux-en-Y method. This reconstruction connects the remaining stomach to the small intestine in a way that allows for better digestion and nutrient absorption.

Purpose

This procedure is performed to treat conditions like stomach cancer, severe peptic ulcers, or severe damage to the stomach lining. The primary goals are to remove diseased or damaged tissue, alleviate symptoms, and prevent further complications.

Indications

Malignant tumors or benign but problematic growths in the lower stomach
Persistent bleeding or severe inflammation from peptic ulcers
Non-cancerous conditions like gastric outlet obstruction
Chronic, severe weight loss due to progressive gastrointestinal symptoms

Preparation

Fasting for at least 12 hours prior to surgery
Discontinuing certain medications, as advised by the doctor
Undergoing preoperative assessments like blood tests, imaging studies, and possible endoscopy
Discussing anesthesia risks and consent forms

Procedure Description

The patient is administered general anesthesia.
A surgical incision is made in the abdomen to access the stomach.
The distal portion of the stomach is carefully removed.
The Roux-en-Y reconstruction is performed by creating a small pouch from the remaining stomach and attaching it to the small intestine (jejunum).
The bypassed portion of the small intestine is then connected to another part further down, forming a Y-shaped configuration.
The incision is closed with sutures or staples.

Tools include surgical scalpels, clamps, sutures, and specialized stapling devices for the gastrointestinal tract.

Duration

The procedure typically takes 2 to 4 hours.

Setting

A hospital or specialized surgical center, equipped with an operating room.

Personnel

General surgeon or gastrointestinal surgeon
Anesthesiologist
Surgical nurses
Possibly a surgical assistant or resident

Risks and Complications

Infection and bleeding
Leakage at the surgical connection sites
Nutrient deficiencies or malabsorption issues
Longer-term risks include bowel obstruction or vitamin/mineral deficiencies

Benefits

Expected benefits include the removal and treatment of malignant or benign growths, relief of symptoms, and improved quality of life. Benefits usually become apparent once initial recovery is complete.

Recovery

Initial hospital stay of about 5 to 10 days for monitoring and early recovery
Gradual return to normal diet, starting with liquids and soft foods
Avoid heavy lifting and strenuous activities for at least 6 weeks
Follow-up appointments for nutritional guidance and to monitor for complications

Alternatives

Total gastrectomy (complete removal of the stomach)
Endoscopic treatments for less severe conditions
Medical management with medications and lifestyle modifications
Palliative care for advanced cancer with a primary focus on comfort

Patient Experience

Patients may experience significant discomfort and pain initially, managed with pain medications. There may be challenges with eating and digestion during the recovery period, which are gradually resolved with dietary adjustments and supplements. Long-term, patients must adopt permanent changes in diet and lifestyle to accommodate the reduced stomach size and altered digestive pathway.