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What is a distal gastrectomy?
A distal gastrectomy or antrectomy removes part of the stomach and stitches the remainder with an opening into the small intestine.
Antrectomy (distal gastrectomy) is a procedure that involves surgical removal of the lower 30% of the stomach (antrum). Distal gastrectomy is a type of partial gastrectomy that involves the surgical removal of only a portion of the stomach.
A partial gastrectomy surgery is followed by a surgery to create a connection (anastomosis) of the remaining portion of the stomach to the duodenum (gastroduodenostomy) or the jejunum (gastrojejunostomy) of the small intestine.
Why is antrectomy (distal gastrectomy) performed?
Antrectomy is mainly indicated in the treatment of gastric ulcers that are:
- not responsive to medication
- complicated by holes (perforation)
- bleeding or obstructing
- recurring
Antrectomy is also indicated in the treatment of noncancerous tumors or for the early stages of cancer involving the lower part of the stomach.
When should an antrectomy be avoided?
Antrectomy should be avoided in the following conditions:
- Anemia
- Hypokalemia (low potassium levels in the blood)
- Hypoproteinemia (low protein level in the blood)
- Severe ascites (fluid in the abdomen)
- Metastasized cancer (cancer spread to other site or area)
- Tumors of the liver or pancreas
- Adhesions as a result of previous surgeries
What happens during the antrectomy surgery?
Before the treatment, you will be counseled regarding the surgery, its complications and its risk and benefits.
Also, some of the instructions which you need to follow before and on the day of surgery are:
- You need to undergo certain tests including an electrocardiogram (EKG), a chest x-ray and blood tests.
- Inform your doctor, if you are on blood thinners such as Coumadin (warfarin) or heparin or any prescription medicines.
- You should refrain from alcohol, cigarette smoking or recreational drugs before the surgery.
- You should stop taking aspirin, herbal remedies, vitamin E and other supplements, seven days before the surgery.
- You need to follow a liquid diet the day before the surgery.
Procedure
During the surgery
- The surgeon makes a cut extending from the chest to the belly button.
- Once the abdomen is open and accessible, the surgeon conducts a thorough evaluation to assess the extent of disease.
- After the assessment, the lower portion of the stomach (antrum) is surgically removed.
- The remaining portion of the stomach is connected with the duodenum or the jejunum of the small intestine.
What are the complications of distal gastrectomy?
Complications of the antrectomy include
- Leakage from the newly connected area
- Infection
- Bleeding
- Blood clots or edema in the newly connected site
- Recurring ulcer disease
- Inflammation in the pancreas
- Dumping syndrome: When the small intestine has to digest a large amount of food at once, it can lead to nausea, diarrhea or vomiting.
- Gastritis (inflammation of the lining of the stomach)
- Increasing blood sugar level
- Fast heart rate
- Feeling lethargic
- Confusion