Name of the Procedure:

Gastrectomy, Total; with Esophagoenterostomy
Common name(s): Total Gastrectomy

Summary:

A total gastrectomy with esophagoenterostomy is a surgical procedure where the entire stomach is removed, and the esophagus is then connected directly to the small intestine. This allows food to bypass the stomach entirely.

Purpose:

This procedure addresses severe medical conditions such as stomach cancer, severe ulcers, non-cancerous polyps, or genetic conditions that predispose individuals to stomach cancer. The goal is to remove diseased tissues, prevent cancer spread, and restore a functional digestive pathway.

Indications:

• Stomach cancer
• Severe peptic or gastric ulcers unresponsive to other treatments
• Gastrointestinal stromal tumors (GISTs)
• Genetic conditions like familial adenomatous polyposis (FAP) or Hereditary Diffuse Gastric Cancer (HDGC)
• Severe, refractory bleeding or perforated ulcers

Preparation:

• Fasting for at least 8 hours prior to surgery
• Temporary discontinuation of certain medications (e.g., blood thinners)
• Pre-operative blood tests, imaging studies (CT scan, endoscopy), and cardiac evaluation
• Consultation with a dietitian for postoperative nutritional guidance

Procedure Description:

1. The patient is administered general anesthesia.
2. A surgical incision is made in the abdomen.
3. The entire stomach is carefully removed.
4. The esophagus is connected to the jejunum (part of the small intestine) in a process called an esophagoenterostomy.
5. Any necessary lymph nodes are also removed.
6. Incisions are closed with sutures or staples.
7. The area is dressed, and the patient is brought to recovery.

Duration:

The procedure typically takes 4-6 hours.

Setting:

Performed in a hospital operating room with facilities for major surgery.

Personnel:

• General surgeon or surgical oncologist
• Anesthesiologist
• Surgical nurses
• Possibly a surgical assistant or resident doctor
• Postoperative care team including nurses and a dietitian

Risks and Complications:

• Infection at the surgical site
• Bleeding
• Blood clots
• Anesthesia complications
• Leakage at the esophagoenterostomy site
• Nutritional deficiencies due to altered digestion
• Dumping syndrome (rapid gastric emptying)
• Delayed gastric emptying

Benefits:

• Potentially curative for stomach cancers and other serious conditions
• Relief from symptoms associated with severe gastric conditions
• Improved quality of life if successful

Recovery:

• Initial hospitalization for 1-2 weeks post-surgery
• Gradual reintroduction of a liquid diet, progressing to soft foods, then regular diet as tolerated
• Pain management with prescribed medications
• Nutritional supplements or adjustments
• Follow-up appointments for regular monitoring

Alternatives:

• Partial gastrectomy (removal of part of the stomach)
• Chemotherapy or radiation therapy (particularly for cancer)
• Endoscopic treatments for less severe conditions
• Conservative management with medications and dietary changes

Patient Experience:

During the procedure, the patient will be under general anesthesia and will not feel any pain. Postoperatively, pain management will include medications like analgesics. Some discomfort and adjustment issues with diet can be expected. Emotional and psychological support may benefit those adjusting to life without a stomach.