43632 Gastrectomy, partial, distal; with gastrojejunostomy

Name of the Procedure:

Partial Distal Gastrectomy with Gastrojejunostomy
Common name(s): Partial Gastrectomy, Distal Gastrectomy

Summary

In layman's terms, a partial distal gastrectomy with gastrojejunostomy involves the surgical removal of the lower part of the stomach. The remaining part of the stomach is then attached to the middle portion of the small intestine (jejunum). This procedure is typically done to remove diseased or damaged tissue in the stomach.

Purpose

The primary purpose of this procedure is to treat conditions such as stomach cancer, severe peptic ulcers, or benign tumors.

Goals:

• Remove diseased or damaged stomach tissue
• Restore gastrointestinal function
• Alleviate symptoms such as pain, bleeding, or obstruction

Indications

• Diagnosed stomach cancer in the distal (lower) part of the stomach
• Severe or recurrent peptic ulcers not responsive to other treatments
• Benign tumors or polyps that impede digestive function
• Chronic gastritis with complications

Patient Criteria:

• General good health otherwise
• Ability to tolerate anesthesia

Preparation

• Fasting for at least 8 hours prior to surgery
• Pre-operative evaluations including blood tests, imaging studies, and sometimes endoscopy
• Adjustments to current medications (some might need to be temporarily stopped)
• Discussion of medical history and potential risks with the surgical team

Procedure Description

1. Administer general anesthesia to ensure patient comfort and unconsciousness during the surgery.
2. Make an incision in the upper abdomen.
3. Identify and isolate the affected part of the stomach.
4. Remove the distal portion of the stomach.
5. Attach the remaining stomach to the jejunum (small intestine) to maintain continuity of the digestive tract.
6. Close the incision with sutures or staples.
7. Complete the procedure with bandaging and post-operative care instructions.

Tools and Equipment:

• Surgical scalpel and retractors
• Suture materials or surgical staplers
• Anesthesia equipment

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity and patient-specific factors.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Surgeon specialized in gastrointestinal or general surgery
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Blood clots

Rare Complications:

• Leakage at the site of the stomach and jejunum connection
• Nutritional deficiencies (e.g., anemia, vitamin B12 deficiency)
• Delayed gastric emptying

Management:

• Antibiotics for infection
• Blood transfusions if necessary
• Monitoring and intervention for nutritional issues

Benefits

• Reduction or elimination of symptoms like pain, bleeding, or obstruction
• Removal of diseased or cancerous tissue
• Improvement in overall digestive function

Realization Timeframe:

Post-operatively within several weeks, although full recovery and digestive normalization may take several months.

Recovery

• Initial hospitalization for 5-7 days post-surgery
• Gradual introduction to eating with a special diet transitioning back to regular foods
• Regular follow-up appointments and monitoring for complications
• Avoiding heavy lifting and strenuous activity for 6-8 weeks

Alternatives

• Endoscopic resection (for smaller lesions or early-stage cancer)
• Chemotherapy or radiotherapy (depending on cancer staging)
• Non-surgical management for ulcers (medications, lifestyle changes)

Pros and Cons:

• Endoscopic Resection: Minimally invasive, quicker recovery; however, not suitable for larger or more invasive lesions.
• Chemotherapy/Radiotherapy: Useful for non-resectable tumors or as adjuvant therapy; potential systemic side effects.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-operatively, they may experience pain at the incision site, which will be managed with pain medications. Gradual improvement in eating and digestive function is expected over the recovery period, and care will be taken to ensure the patient's comfort and well-being.