Introduction
A gastrectomy is a complex and major surgical procedure that involves the partial or total removal of the stomach. The stomach is a key organ in the digestive system responsible for breaking down food and mixing it with digestive enzymes before it enters the small intestine. This surgery is most commonly performed as a primary treatment for stomach (gastric) cancer. However, it may also be necessary to address severe, bleeding peptic ulcers that do not respond to medication, large noncancerous polyps, or in some specific cases, life-threatening obesity. Living with a partially or fully removed stomach is possible, but it requires profound, lifelong changes to a patient’s diet, eating habits, and nutritional management to maintain health and prevent severe weight loss or vitamin deficiencies.

Surgical Procedure
A gastrectomy is performed under general anesthesia and can be executed via open surgery or minimally invasive laparoscopic (or robotic) techniques.
In a partial gastrectomy, the surgeon removes the lower half of the stomach (where most cancers and ulcers occur). The remaining upper portion of the stomach is then surgically connected to the small intestine to restore the digestive tract.
In a total gastrectomy, the entire stomach is removed. The surgeon then attaches the esophagus directly to the small intestine. This is a highly complex reconstruction.
During either procedure for cancer, the surgeon will also remove surrounding lymph nodes to test for the spread of the disease. The incisions are closed with sutures or staples. The surgery typically takes several hours.

Surgical Risks
As a major abdominal surgery, gastrectomy carries substantial risks, including severe adverse reactions to anesthesia, significant blood loss requiring transfusions, and the risk of deep vein thrombosis or pulmonary embolism.

General Complications
Common post-operative complications include:
– “Dumping Syndrome”: A frequent and challenging complication where food moves too quickly from the esophagus or remaining stomach into the small intestine. This causes nausea, severe abdominal cramping, diarrhea, sweating, dizziness, and a rapid heart rate shortly after eating.
– Significant weight loss and difficulty maintaining a healthy weight.
– Vitamin and mineral deficiencies, particularly Vitamin B12, iron, and calcium, leading to anemia or osteoporosis.
– Acid reflux or bile reflux into the esophagus, causing heartburn.

Rare but Serious Complications
– Anastomotic leak: A life-threatening complication where the surgical connection between the esophagus/stomach and the intestine leaks digestive fluids into the abdomen, causing peritonitis.
– Severe internal bleeding or infection.
– Stricture: Narrowing of the surgical connection over time, making it difficult to swallow food.

Pre-operative Preparation
– Comprehensive Evaluation: Extensive imaging (CT, PET scans), endoscopy, blood tests, and nutritional assessments.
– Nutritional Optimization: Patients who are malnourished may need a feeding tube or IV nutrition before surgery to improve their strength.
– Fasting: Strict fasting from midnight before the surgery.
– Smoking Cessation: Essential to reduce respiratory complications and promote healing.

Post-operative Care
Patients typically spend 1 to 2 weeks in the hospital. You will not eat or drink by mouth for several days to allow the surgical connections to heal. Nutrition and fluids will be provided intravenously (IV) or through a temporary feeding tube placed directly into the intestine during surgery. A tube may also be placed through your nose into your stomach/intestine to keep it empty of digestive juices. Once the doctor confirms the connections are secure (often via an X-ray swallow test), you will slowly begin drinking clear liquids.

Wound Care
– Keep the abdominal incisions clean and dry. Follow specific nursing instructions for showering.
– Inspect the wounds daily for signs of infection (redness, swelling, pus, fever).
– Manage surgical drains if you are sent home with them, recording output daily.

Diet
Dietary changes are the most significant aspect of recovery.
– You must eat 6 to 8 very small meals a day, as you have little to no stomach capacity to store food.
– Chew food thoroughly until it is a liquid consistency before swallowing.
– Do not drink fluids with meals; drink them 30-45 minutes before or after to prevent filling up too quickly and to reduce Dumping Syndrome.
– Avoid high-sugar foods and simple carbohydrates, which trigger Dumping Syndrome. Focus on high-protein, nutrient-dense foods.

Post-discharge Notes
Full physical recovery can take months, and dietary adaptation is a lifelong process.
– Avoid heavy lifting and strenuous activity for at least 6 to 8 weeks.
– You will require lifelong Vitamin B12 injections (since the stomach can no longer absorb it from food) and regular blood tests to monitor iron, calcium, and other nutritional levels.
– Work closely with a specialized dietitian to manage your new eating habits and maintain your weight. Contact your doctor immediately for severe abdominal pain, vomiting, fever, or difficulty swallowing.