Purpose of Gastrectomy Surgery

A gastrectomy is a surgery in which part or all of the stomach is removed. A gastrectomy may be used to treat obesity, peptic ulcers, a perforation (hole) in the stomach, or some forms of cancer.

When part of the stomach is removed, it is called a partial, or a subtotal, gastrectomy. When the fundus (the largest part of the stomach) is removed, it is called a sleeve gastrectomy, and is often done as a weight-loss surgery.

An esophagogastrectomy is when the upper part of the stomach and part of the esophagus is removed, which might be done for cancer in the stomach that has spread to the esophagus. A total gastrectomy is when all of the stomach is removed, which might be done for stomach cancer or for other reasons.

Diagnosis Related to Gastrectomy

The stomach is an organ in the digestive tract between the esophagus and the small intestine. The stomach is where food is processed in order to remove nutrients. Removing a part, or all, of the stomach, means that food will be processed and digested in a different way.

There are several reasons why a gastrectomy might be done. Whether a portion of the stomach or the entire stomach is removed will depend on the reason for the surgery.

Stomach Cancer

The number of people being diagnosed with stomach cancer has been decreasing in the last century. However, even though rates are the lowest they have ever been in the United States, stomach cancer still continues to be a problem for certain groups, including Black, Asian and Pacific Islander, American Indian and Alaska Native populations.

Stomach cancer is often not diagnosed until it is advanced, which means that deaths from this type of cancer continue to be high. Surgery is often used to treat stomach cancer at all stages, even when it is caught early.

The type of surgery and how much of the stomach is removed will depend on how extensive the cancer is in the stomach and if the cancer has spread into other organs (such as the esophagus). For cancer that has progressed, there may be other treatments used along with gastrectomy surgery, such as chemotherapy and/or radiation. 

Obesity

As of 2020, obesity affected approximately 42% of Americans. Gastrectomy may be used as a type of bariatric surgery to treat obesity. This type of surgery may be a sleeve gastrectomy or a vertical sleeve gastrectomy.

A sleeve gastrectomy is often done laparoscopically, which is less invasive than open surgery because it is completed through the use of fiber-optic tools and only a few small incisions. About 80% of the stomach is removed during gastric sleeve surgery.

Peptic Ulcers

Ulcers in the stomach, which are open sores that cause pain and bleeding, might be treated with gastrectomy surgery in some cases. Peptic ulcers can be caused by infection with a type of bacteria (Helicobacter pylori), the use of non‐steroidal anti‐inflammatory drugs (NSAIDs), and smoking cigarettes.

Gastric Polyps

Outgrowths in the stomach, called polyps, are rare. In some cases, they may be caused by rare inherited diseases. Polyps may become cancerous. Stomach polyps may or may not cause any symptoms.

Perforation

A perforation through the stomach wall is an emergency, therefore surgery will be done. In some cases, the perforation might be closed up without the removal of part of the stomach. However, if the damage is extensive, there might be a need to remove some part of the stomach.

Criteria

To receive gastrectomy surgery, a person will need to be considered a good candidate. This means, in the case of cancer or illness, that the surgery is expected to be low risk and will be of an overall benefit in treating the condition.

Stomach Cancer

For stomach cancer, gastrectomy is a first-line therapy, meaning that surgery will be recommended for most patients. The extent of the surgery, and how much of the stomach is removed, will depend on the stage of the cancer and if the cancer has spread beyond the stomach.

Obesity

For gastrectomy for weight loss, patients will need to meet certain criteria and may also be evaluated by a team of healthcare professionals. Gastrectomy may be used as a treatment for those who have a body mass index (BMI) more than 40, or who are 100 pounds over their ideal body weight.

It may also be considered for those whose BMI is 35 and up and who also have another condition that is affecting weight loss, or for whom other weight loss methods (such as diet and lifestyle changes) have not been effective.

Peptic Ulcers

Surgery is not usually the first line of treatment for ulcers. Medication, such as proton pump inhibitors, are often used as the first line of treatment for ulcers.

However, for ulcers that won’t heal after eight to 12 weeks of treatment or for patients that are unable to receive medical treatment, surgery might be considered. A partial gastrectomy is typically the type of surgery that is used.

Gastric Polyps

In some cases, when polyps are found in the stomach they might be removed through endoscopy, where instruments are passed through the mouth and down through the esophagus and into the stomach.

Less commonly, when there is a high risk of cancer because there are many polyps or the polyps grow back quickly, gastrectomy might be used as a treatment.

Perforation

A perforation through the entire stomach wall is an emergency, therefore surgery will usually be needed. In some cases, the perforation might be closed up without removal of part of the stomach. However, if the damage is extensive, there might be a need to remove some part of the stomach.

Tests and Labs

One or more of several tests might be done to find problems with the stomach that could lead to gastrectomy. These might be done when there are symptoms that suggest a stomach issue or if a gastrectomy is being considered to treat obesity.

For stomach problems, patients may be referred to a gastroenterologist (a physician that specializes in digestive conditions) who may order one or more of these tests:

• Biopsy (tissue taken from the stomach to be tested in a lab)
• Chest X-ray (to determine if cancer has spread beyond the stomach)
• Computed tomography (CT or CAT) scan
• Endoscopic ultrasound
• Magnetic resonance imaging (MRI) scan
• Upper endoscopy or esophagogastroduodenoscopy (EGD)
• Upper GI series

A Word From Verywell

Because stomach cancer is on the decline and peptic ulcers are most often treated with medication, gastrectomy surgery is most commonly used to treat obesity. In the management of recurring peptic ulcers, it’s unclear if treating with medications or treating with surgery provides better outcomes for patients.

All patients who have surgery on the stomach will receive special instructions on diet and nutrition because it will be important to eat foods that are tolerated well and also provide the right balance of nutrients.