Resection of the stomach

The most frequently performed surgery for duodenal and stomach diseases is gastrectomy.

The operation is based on excision of the affected part of the organ. In this case, the restoration of the continuity (integrity) of the gastrointestinal tract is carried out by imposing an anastomosis between the jejunum or duodenum and the stump of the stomach.

Operative intervention can be carried out by two main methods.

When using the first method (Billroth I) resection of the stomach is made by total excision of its antral and pyloric sections. In this case, the anastomosis is applied between the lower part of the stump of the organ and duodenum according to the principle of "end-to-end".

Resection of the stomach by this method can lead to a rather dangerous complication, manifested in an insufficient tightness of the anastomosis at the junction of the three joints. To solve it, there are many different modifications. The most commonly used modification is Haberera II. In this operation, after excision of 2/3 of the stomach and mobilization, narrowing of its lumen is made by means of corrugating sutures in such a way that its width is equal to the width of the lumen in the duodenum.

Resection of the stomach with the application of the method of Billroth II is carried out by sewing tightly the stump of the organ. To restore the continuity of the gastrointestinal tract in this case, a superposition of the posterior or anterior gastroenteroanastomosis is performed.

The choice of the method of excision is carried out taking into account the type of pathology, its location and the size of the excised area of the stomach.

There are relative and absolute indications for the operation of excision.

Absolute malignant neoplasms, recurrent ulcer bleeding, suspicion of malignant malignancy, and stenosis of the pylorus are considered to be absolute.

Relative indications include long-lasting ulcers in the duodenum and stomach, as well as perforated ulcers against the background of a patient's good condition, which occurred within the first six hours after perforation.

In the presence of malignant neoplasms and peptic ulcer, the operation is performed using a special technique.

So, with peptic ulcer it is advisable to excrete 2/3 or 3/4 of the body of the stomach with the pyloric department. Thus, the relapse of the disease is prevented. In cases of development of high seated ulcers of low curvature subtotal resection of the stomach is used. In this case, excision of 4/5 organ is performed (almost 80%).

Diet after gastrectomy involves limiting the amount of food eaten at a time. Thus, patients are not recommended more than 250 grams of soup or one glass of drink. At lunch you can eat no more than two dishes. Eating during the day is recommended frequent (at least five to six times). It is recommended to increase the amount of protein taken (up to 120 g), limiting the amount of carbohydrates (up to 300 g). In some cases, sugar-containing dishes and drinks can be completely excluded. It is allowed to use sugar substitutes. To increase the amount of protein recommended boiled meat, fish, calcined or grated cottage cheese, omelet from egg white.

It is advisable to include in the diet and dietary products enriched with vegetable oils. In case of poor portability, in particular, in a free form, their amount is limited to 70-80 grams per day. In case of intolerance of milk in its free form, it is only included in the composition of dishes or replaced with other products.

In the diet must also include preparations containing iron and multivitamins.

In the case of a decrease in weight in patients, it is allowed to increase the energy value of the dishes by 10-15% relative to the physiological norm.