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Stomach Surgeries


Stomach cancer has to be staged before deciding upon the type of surgery if part or all of the stomach has to be removed. Even as some part of the stomach may be left behind, other organs may have to be resected along with it. Surgery is the only cure for stomach cancer. Usual stages of stomach cancer (like any other) where elective surgery is performed are stage 0, I, II and III, with appropriate patient health.

Sometimes the cancer may have spread making it almost impossible to the removed. At this time, a palliative surgery is extremely helpful in preventing blockages and bleeding of the tumour. This relieves symptoms and does not necessarily cure the cancer.

Techniques

Total gastrectomy: All of the stomach is removed in a total gastrectomy. An incision is made either vertically or horizontally at the abdomen. The procedure is generally applied when the cancer has spread all over the upper or middle part of the stomach. The lymph nodes will also be removed along with a portion of the oesophagus together with the omentum. A part of the small intestine is attached to the end of the oesophagus. Patients who have undergone total gastrectomy have a limited intake of food at a single time though they may have to eat frequently. The reconstruction after total gastrectomy is called the Roux-en-Y reconstruction.

Partial gastrectomy: Also known as subtotal gastrectomy, the procedure is done when cancer has spread through the lower part of the stomach connecting to the duodenum. Partial gastrectomy removes only part of the stomach. The lymph nodes around the stomach and a portion of the omentum are also removed. The cardiac sphincter or valve between the oesophagus and the stomach is left intact. Eating is easier than total gastrectomy.

Endoscopic resection: The tumour or part of the cancerous organ is cut out in an endoscopic resection. An endoscope, which is a long, flexible tube is used, inserted into the stomach through the mouth and down the throat. Endoscopic resection is carried out for early-stage cancers.

Oesophagogastrectomy: Part of the oesophagus is removed when the cancer is located in the area where the stomach joins it. The lowest third of the stomach is converted into a tube and the rest of the oesophagus is connected to the stomach. An abdominal wound and a chest wound are made during this operation.

Laparoscopic antireflux surgery: Moderate to severe heartburns will require a laparoscopic antireflux surgery. A piercing burning sensation occurs right below the neck and in between the ribs, which radiates through the chest, throat and neck. The LES or the lower oesophageal sphincter located at the lower end of the oesophagus functions as a valve that prevents backing-up of stomach juices. During GERD the functionality of the LES is compromised causing high acid content to flow back into the lower oesophagus leading to burns. As a result, the cells in the lower oesophagus undergo changes inducing Barrett s oesophagus. Reflux can also be due to a condition called hiatus hernia. This is a strong indication for laparoscopic anti reflux surgery.

We also conduct palliative surgeries such as gastrojejunostomy and feeding tube placement for cancers that cannot be removed. We are an expert in laparoscopic surgery for reflux disease.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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