What is Total Gastrectomy?

Total gastrectomy is a surgery to remove the entire stomach. This is done to treat stomach cancer.

During a total gastrectomy, the tube that moves food from the mouth to the stomach (esophagus) is connected directly to the small intestine. This allows you to continue to eat and digest food after the stomach is removed. The surgery may be done:

• Through one large incision (open technique).
• Through several small incisions using a thin, pencil-sized instrument that has a light and camera on the end (laparoscope). This is called laparoscopic surgery.
• Through a combination of large and small incisions.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding or blood clots.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Bulging of an organ or tissue through a weak spot in the muscles of the abdomen (hernia).
• Leaking at the site where the esophagus is connected to the small intestine.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicine

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Your health care provider may ask you to take certain medicines, such as antibiotic medicines or stool softeners, before the procedure.

General instructions

• To reduce your risk of infection, you may be asked to shower with a germ-killing soap.
• Plan to have someone take you home from the hospital or clinic.
• Arrange for someone to help you with your activities during your recovery.
• Make sure to see your health care provider for any tests that you need before the procedure, such as:
  • Blood tests.
  • Stool tests.
  • Imaging tests, such as X-rays, CT scans, or an ultrasound.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins. The tube will be used to give you medicine.
• You will be given a medicine to make you fall asleep (general anesthetic).
• A thin tube (catheter) may be placed in your bladder to drain urine.
• Compression stockings may be placed on your lower legs. These stockings help to prevent blood clots and reduce swelling in your legs.
• A tube (nasogastric tube) will be inserted through your nose or mouth and into your stomach to drain stomach fluids.
• If you are having open surgery, a large incision will be made in your abdomen.
• If you are having laparoscopic surgery:
  • A few small incisions will be made in your abdomen.
  • A laparoscope will be put into one of the incisions. The laparoscope will send images to a computer screen in the operating room to give your surgeon a good view of your stomach.
  • Other surgical instruments will be inserted through the other incisions.
• Your entire stomach will be removed.
• Your esophagus will be connected to your small intestine. Depending on your condition, your surgeon may also remove your lymph nodes, your spleen, or parts of your pancreas or other nearby organs.
• A feeding tube (gastric tube) may be placed into your small intestine. This can be used to provide liquid nutrition if you are not able to take enough food by mouth after surgery to meet your needs.
• Your incision(s) will be closed with staples, stitches (sutures), or skin glue.
• A bandage (dressing) may be placed over the incision(s).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may continue to have:
  • Compression stockings on your lower legs.
  • A catheter draining your urine. Your catheter will be removed after you are awake and able to pass urine on your own.
  • A gastric tube.
  • An IV tube inserted in one of your veins. You will continue to receive nutrition and pain medicine through an IV tube. When you are able to drink fluids well and take pain medicine by mouth, your IV tube will be removed.
• After a few days, you may be started on a liquid diet. Soft foods will be added to your diet as soon as your health care provider thinks you can begin eating small, frequent meals.
• You will be encouraged to walk around several times a day. This helps to prevent blood clots.

Total Gastrectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Abdominal pain or cramping that is often worse after eating.
• Heartburn and diarrhea after eating. This usually goes away with time.
• Nausea and vomiting.
• Weight loss.
• Lack (deficiency) of certain vitamins.
• Abdominal swelling.

Follow these instructions at home:

Activity

• Get plenty of rest, but move around often for short periods or take short walks.
• Gradually increase your activity.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 10 lb (4.5 kg) for 6–8 weeks or for as long as told by your health care provider.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive for 24 hours after the procedure if you were given a medicine to help you relax (sedative).
• Do not drive or use heavy machinery while taking prescription pain medicine.

Incision care

• Follow instructions from your health care provider about how to take care of your incision(s). Make sure you:
  • Keep the incision(s) clean and dry.
  • When your health care provider approves, clean the incision area by washing with soap and water, rinsing well, and patting the area dry. Do not rub the incision(s) with a washcloth or towel. Do not use creams, ointments, or anything else to clean the incision(s).
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision(s) every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Eating and drinking

• Follow instructions from your health care provider about eating and drinking. You may need to:
  • Eat small amounts of food throughout the day instead of large meals. Eating meals that are too big can cause a condition called dumping syndrome, which causes cramps, nausea, dizziness, and discomfort.
  • Eat foods that have a lot of calcium, iron, vitamin C, vitamin D, and fiber, such as whole grains and fresh fruits and vegetables.
  • Avoid spicy foods.
  • Avoid acidic foods and drinks, such as tomatoes and orange juice.
  • Keep a food diary. Write down any problems that develop during the day. Keeping a food diary can help you figure out which foods cause problems for you.

General instructions

• Take sponge baths. Do not shower, take a bath, or go swimming until your health care provider approves.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important. During these visits, your health care provider may check to make sure that you are getting enough vitamins. You may also get an injection of vitamin B.

Contact a health care provider if:

• These symptoms do not improve with medicine or treatment as told by your health care provider:
  • Pain.
  • Nausea and vomiting.
  • Heartburn.
  • Diarrhea.
• You have pain, bloating, pressure, or cramping in your abdomen.
• You become confused.
• You feel light-headed or dizzy.
• You develop new symptoms.
• You have redness, swelling, or pain around your incision(s).
• You have fluid or blood coming from your incision(s).
• You have pus or a bad smell coming from your incision(s).
• Your incision area feels warm to the touch.
• You have a fever or chills.
• You are not able to take your medicine as told by your health care provider.

Get help right away if:

• You have abdominal pain that does not go away or becomes severe.
• You have persistent vomiting.
• You cannot drink fluids.
• You develop an irregular heartbeat.
• You develop chest pain.
• You develop swelling or pain in your legs, feet, or the back of your lower legs (calves).