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||This article may be expanded with text translated from the corresponding article in the Japanese Wikipedia. (July 2013)|
Diagram of the stomach, showing the different regions.
A gastrectomy is a partial or full surgical removal of the stomach.
Gastrectomies are performed to treat cancer and perforations of the stomach wall.
In severe duodenal ulcers it may be necessary to remove the lower portion of the stomach called the pylorus and the upper portion of the small intestine called the duodenum. If there is a sufficient portion of the upper duodenum remaining a gastroduodenostomy is performed, where the remaining portion of the stomach is reattached to the duodenum before the bile duct and the duct of the pancreas. If the stomach cannot be reattached to the duodenum a gastrojejunostomy is performed, where the remaining portion of the duodenum is sealed off, a hole is cut into the next section of the small intestine called the jejunum and the stomach is reattached at this hole. As the pylorus is used to grind food and slowly release the food into the small intestine, removal of the pylorus can cause food to move into the small intestine faster than normal, leading to gastric dumping syndrome.
A type of posterior gastroenterostomy which is a modification of the Billroth II operation. Resection of 2/3 of the stomach with blind closure of the duodenal stump and retrocolic anastomosis of the full circumference of the open stomach to jejunum.
The most obvious effect of the removal of the stomach is the loss of a storage place for food while it is being digested. Since only a small amount of food can be allowed into the small intestine at a time, the patient will have to eat small amounts of food regularly in order to prevent gastric dumping syndrome.
Another major effect is the loss of the intrinsic-factor-secreting parietal cells in the stomach lining. Intrinsic factor is essential for the uptake of vitamin B12 in the terminal ileum and without it the patient will suffer from a vitamin B12 deficiency. This can lead to a type of anemia known as megaloblastic anaemia (can also be caused by folate deficiency, or autoimmune disease where it is specifically known as pernicious anaemia) which severely reduces red-blood cell synthesis (known as erythropoiesis, as well as other haemotological cell lineages if severe enough but the red cell is the first to be affected). This can be treated by giving the patient direct injections of vitamin B12.
The first successful gastrectomy was performed by Theodor Billroth in 1881 for cancer of the stomach.
- E. Pólya:Zur Stumpfversorgung nach Magenresektion. Zentralblatt für Chirurgie, Leipzig, 1911, 38: 892-894.
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