Stomach resection

Gastric resection is a surgical procedure that removes part of the stomach and restores the continuity of the digestive tract. The size of the resection can be significant (from 1/3 to 4/5 of the stomach). The main indications for gastric resection surgery are tumor formations (malignant or benign tumors of large sizes), as well as ulcerative bleeding, not amenable to hemostatic (hemostatic) therapy.

The volume of the resected area is determined strictly individually. Before determining the type of resection, surgeons take into account the stage of cancer, the histotype, and the size of the tumor. So, in case of a large tumor with damage to all regional lymphatic barriers, but without distant metastases, it is necessary to perform a maximum-volume operation. With a small tumor within the mucous membrane, a small resection (for example, two-thirds of the stomach) can be performed, but at the same time, the entire regional lymphatic apparatus can be removed as much as possible, since in these cases the absence of metastases can never be guaranteed.

Types of gastric resection

There are two main types of resection:

distal subtotal resection of the stomach (the lower segment of the stomach located in front of the duodenum is removed, performed transperitoneally);
proximal subtotal resection of the stomach (part of the organ near the esophagus is removed, performed by transperitoneal and transpleural access).

Smaller resections (2/3 or 3/4 of the stomach) are used only in the presence of small exophytic tumors of the pyloroantral part of the stomach or as palliative surgery.

How is gastric resection performed?

There are two ways to operate:

resection of the stomach according to Billroth 1 - after removal of a part of the stomach, the stump is sutured from the side of the lesser curvature but remains unstitched from the side of the greater curvature. An end-to-end anastomosis is applied between the stomach stump and the duodenum. The advantages of this type are that the gastric mucosa is connected to the duodenal mucosa, as in normal conditions, while maintaining the normal functioning of the digestive system.
resection according to Billroth 2 - the stumps of the stomach and duodenum are sutured tightly, and then a gastro-jejunal anastomosis is created in the "side-to-side" type.

Distal subtotal resection of the stomach is an operation performed in the presence of a tumor in the pyloric antrum or the lower third of the body of the stomach. The scope of the operation includes the removal of 4/5 of the stomach with the obligatory performance of lymph node dissection - a monoblock removal of lymph nodes and lymphatic vessels with the surrounding fatty tissue within fascial cases with high ligation of the vessels supplying the stomach. It is performed for fundamental reasons, regardless of the presence or absence of metastases in regional lymph nodes. Also, with the spread of metastases, the spleen and pancreas are removed. When the tumor spreads to neighboring organs, their resection is also performed. The operation is completed by restoring the continuity of the gastrointestinal tract by forming an anastomosis between the rest of the stomach and the small intestine. In all other cases, the operation is completed according to the Billroth method, and 2.

Proximal subtotal gastric resection is an operation performed when the tumor is located in the cardia and the absence of metastases in the lymph nodes of the gastric colic ligament along the greater curvature. This operation can be performed provided that the stomach is large enough, which allows you to retreat from the edge of the tumor by at least 4-5 cm downward and form a tube of great curvature of sufficient length and width. The operation is possible only if all minor curvature is removed. The tube from the greater curvature of the stomach should be 4-6 cm wide and of sufficient length.

The cost of gastric resection in Ukraine

The cost of gastric resection in the clinics of MC "Dobrobut" in each case is individual and depends on the type of resection, technique, and level of complexity of the operation. The cost of gastric resection also depends on the preoperative preparation, the time of the patient's stay in the clinic. You can sign up for a consultation with a doctor in Kyiv by ordering feedback on our website or by calling the call center number.

Bibliography

Стилиди И.С. и др. Возможности улучшения качества жизни больных после одномоментной субтотальной резекции и пластики пищевода по поводу рака // Рос. онкологический журн. - 2007. - № 5.
149. Федоров С.П. «К оценке способов резекции желудка» Новый хирургический архив 1924, 1, - С. 125-130
66. Земляной А.Г. Резекция желудка / А.Г. Земляной // Ленинград. Медицина. –1973.– 192 с.