Gastrectomy

Overview

A gastrectomy is an operation to remove part or all of your stomach. It is done when the stomach is badly damaged, bleeding, blocked, or has a growth that needs to come out — most often stomach cancer. There are two main types: a partial gastrectomy, where only part of the stomach is removed, and a total gastrectomy, where the whole stomach is removed. After the operation, your food pipe (oesophagus) is joined straight to your small bowel. Food still travels through your body, so you can eat and digest — but you will need to eat in a new way, in smaller amounts more often, and you will probably need vitamin and mineral supplements for life.

It is not one of the most common operations, but it is a standard and well-tested procedure. How often it is done varies a lot around the world. It is more common in countries with stomach cancer screening programmes, such as Japan and Korea, because cancers are found earlier there. A related operation, sleeve gastrectomy, is also done as weight-loss surgery.

It is mostly done in adults, usually over the age of 50, who have stomach cancer or a serious stomach problem such as heavy bleeding, a hole in the stomach wall, or a blockage. It is rare in children. Because the stomach is removed or reduced, everyone who has this surgery needs long-term support with eating and nutrition.

Symptoms

Common symptoms

• Symptoms of the problem that may lead to surgery: indigestion or stomach pain that does not settle, especially if it keeps coming back
• Feeling full very quickly, bloating, or losing weight without trying
• Feeling sick or being sick, sometimes with blood in it
• Black, tar-like stools or blood in the stool — a sign of bleeding inside the stomach
• Feeling very tired, weak or short of breath, which can be caused by low iron levels from slow bleeding
• After surgery: feeling full after only a few mouthfuls, so you need to eat little and often
• After surgery: cramping, loose stools, sweating or feeling light-headed soon after eating (this is often called 'dumping syndrome')
• After surgery: heartburn, a bitter taste in the mouth, or more wind and burping

Symptoms in children

• Gastrectomy is rare in children. When it is needed, it is usually after a serious injury, a problem present from birth, or very severe stomach disease.
• Children may need feeding support through a tube for a while, and growth and nutrition are watched closely.
• A specialist children's surgical and dietetic team will usually lead care.

Symptoms in older adults

• Older adults are the group most likely to need this surgery.
• Recovery can take longer, and other health conditions such as heart, lung or kidney problems are checked carefully before the operation.
• Extra help with nutrition, muscle strength and daily activities after surgery often makes recovery smoother.

Causes

Main causes

• Stomach cancer, or changes in the stomach lining that could turn into cancer
• Stomach ulcers that bleed heavily, keep coming back, or make a hole in the stomach wall
• A blockage at the lower end of the stomach that stops food passing through
• Serious injury to the stomach or upper gut
• Some non-cancer growths in the stomach that cannot be removed in another way
• For weight-loss surgery, a sleeve gastrectomy removes most of the stomach to help with severe obesity and related health problems

Risk factors

• A common stomach infection called Helicobacter pylori (H. pylori) that is not treated
• Smoking
• A family history of stomach cancer
• A diet high in very salty, smoked or pickled foods, and low in fruit and vegetables
• Long-term inflammation of the stomach lining (atrophic gastritis)
• Getting older, and being male
• Obesity, when the operation is being done as weight-loss surgery

When to see a doctor

See a doctor urgently if:

• Stomach pain, indigestion or feeling sick that keeps coming back over weeks
• Losing weight without trying, or feeling full very quickly
• Vomiting blood or passing black tar-like stools
• After surgery: any of the urgent or emergency symptoms listed above
• After surgery: being unable to eat or drink enough, or repeated vomiting

Book a routine appointment if:

• Before surgery: questions about what the operation involves and how it will change your eating
• After surgery: tiredness, low energy, or numbness and tingling in the hands and feet (which can point to low vitamin levels)
• After surgery: ongoing loose stools, bloating or discomfort after eating
• After surgery: feelings of low mood, worry or difficulty adjusting to the change

Diagnosis

A gastrectomy is not a diagnosis — it is a treatment. Your doctors first work out exactly what is happening in your stomach, and then decide whether surgery is the best option for you. If surgery is planned, you will usually have tests to check your general health and to make sure you are fit for the operation.

Tests that may be done

• A camera test down the throat into the stomach (endoscopy), often with a small sample of tissue taken (a biopsy)
• Scans such as a CT scan to look at the stomach and nearby organs
• Blood tests to check blood counts, iron levels, liver and kidney function
• A test where you swallow a drink that shows up on X-ray, to see how the stomach is working
• Sometimes a small keyhole look inside the abdomen (laparoscopy) to plan the operation
• Heart and breathing checks before surgery, such as an ECG and breathing tests
• A talk with a dietitian about your weight, eating habits and nutrition plan

What to expect at your appointment

Before the operation you will usually have a meeting with your surgeon to talk through the plan, the risks and the benefits, and to ask questions. You will also be told when to stop eating and drinking beforehand and what to expect when you wake up. After surgery, you will be cared for on a hospital ward, gradually start drinking and eating again with guidance, and be given a follow-up plan including dietitian visits and blood tests.

Treatment

Surgery is the main treatment when the stomach itself needs to be removed or reduced. Depending on the reason for the operation, your team may also recommend other treatments before or after surgery, such as chemotherapy or radiotherapy for cancer, or nutrition support if you have lost weight. The operation can be done through one large cut (open surgery) or through several small cuts using a camera (keyhole surgery). Your surgical team will discuss which is safer and better for you. As with any operation, there are risks, such as bleeding, infection, a leak where the join is made, or narrowing of the join — your team will explain these and how they are managed.

Self-care at home

• Eat small portions more often — three small meals and two or three snacks a day often works better than three large meals
• Eat slowly, chew well, and stop as soon as you feel full
• Sip fluids between meals rather than with meals, so you have room for food
• Keep gently active — short walks help your circulation, your muscles and your mood
• Follow your wound care advice and keep follow-up appointments, including blood tests
• Keep a simple food and symptom diary to spot what suits you and what does not

Medical treatments

Your team may use medicines to control pain, sickness and stomach acid, and may prescribe vitamin and mineral supplements such as iron, calcium, vitamin B12 and vitamin D. Some people need nutrition given through a tube or a drip for a short time. If the operation was for cancer, you may be offered chemotherapy or radiotherapy, and you will have regular check-ups and scans. Your team will also watch for low vitamin levels and bone health over the long term.

When is surgery considered?

A gastrectomy is considered when other treatments are unlikely to work or are not safe enough — for example, for a stomach cancer that can be removed, for ulcers that keep bleeding or will not heal, for a hole or blockage in the stomach, or for a serious injury. In weight-loss surgery, a sleeve gastrectomy may be offered when other approaches have not helped enough. The decision is always made together with you, weighing the benefits against the risks.

Living with this condition

Life after a gastrectomy settles into a new rhythm. Food still moves through your body, but it reaches your bowel more quickly, so you will need to eat smaller amounts more often and may notice some wind, gurgling or loose stools, especially early on. Many people find that certain foods — often very sweet, very fatty or very large portions — cause discomfort, and they learn which foods suit them. Over weeks and months, most people build a routine that works for them and get back to work, hobbies and family life.

Lifestyle tips

• Plan meals and snacks ahead so you are not caught out without suitable food
• Avoid very sugary foods and drinks on their own, as they can trigger cramping and light-headedness
• Limit alcohol, which can hit harder after surgery, and avoid smoking
• Take any recommended vitamin and mineral supplements as advised — they are an important part of staying well
• Keep a healthy weight with regular gentle activity and enough protein to protect your muscles
• Have your blood tests when they are due, even if you feel well

Diet and exercise

Eating well after surgery is about quality and timing rather than quantity. Choose soft, moist, protein-rich foods such as eggs, fish, soft beans, yoghurt and well-cooked vegetables, and chew thoroughly. Build up to regular movement — walking, housework, gardening and light strength exercises — which helps your muscles recover and supports your mood. A specialist dietitian can tailor a plan to your needs and adjust it as you recover.

Mental health and emotional wellbeing

It is common to feel anxious, low, or frustrated while adjusting to a new way of eating and a changed body. Some people worry about eating in front of others or about whether they will feel well enough to do normal things. These feelings usually ease with time and support, but they are worth talking about. If low mood, worry or distress is affecting your daily life, tell your doctor or specialist team — help is available. If you ever feel you might harm yourself, contact your local emergency number or a crisis support line in your country straight away.

Prevention

The operation itself cannot be prevented, but some of the problems that lead to it can be lowered in risk. Not smoking, keeping to a healthy weight, eating plenty of fruit and vegetables, and cutting back on very salty, smoked or pickled foods all help. If you have been told you have an H. pylori stomach infection, getting it treated is worthwhile. If you have long-term stomach problems or a family history of stomach cancer, ask your doctor whether you should be checked.

Screening programmes

Some countries run stomach cancer screening programmes for people at higher risk, and some offer checks for people with a strong family history. Screening advice varies a lot by country, so ask your doctor or local health service what applies to you. In general, it is sensible to get persistent indigestion, stomach pain or unexplained weight loss checked rather than waiting.

Complications

If left untreated

• If the underlying problem is not treated, stomach cancer can grow and spread, which makes treatment harder
• Ongoing bleeding from the stomach can lead to serious anaemia, tiredness and breathlessness
• An ulcer that makes a hole in the stomach wall can cause a life-threatening infection of the abdomen
• A blockage can cause repeated vomiting, dehydration and weight loss
• Long-term poor eating and bleeding can lead to malnutrition and weaker bones

Long-term outlook

For many people, a gastrectomy either cures the problem or gives good control of it, and most adjust over time to a new way of eating. Recovery is usually measured in weeks to months rather than days, and it is normal to have good days and harder days along the way. Long-term follow-up, vitamin checks and support from your team make a real difference. If you have had surgery for cancer, your team will talk with you honestly about your outlook and the treatments that can help.

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