Gastric longitudinal, Billroth 1 and 2, nutrition and dietetics

Gastrectomy

Surgery, during which removed 2/3 or 3/4 of the stomach is affected, called a resection. This procedure is traumatic, so it is prescribed only in the most extreme cases where other treatment could not help. When there is resection of the stomach, cut out the affected part of the body, and then there is the restoration of continuity between the duodenum and the stump. Let’s see how effective this operation.

What is a gastrectomy?

Resection (removal) of the stomach (code according to the international classification of diseases K91.1) necessary, when you become powerless conservative methods of treatment. It is prescribed to patients diagnosed with cancer, ulcers, polyps and other diseases of the gastrointestinal tract. Gastric surgery is carried out in several ways:

  1. Partial resection of the lower part of the stomach, when the preserved portion is connected to the duodenum.
  2. Partial resection of the upper part of the stomach, when cut the upper region, which is involved in the pathological process, and then carried out a further connection of the esophagus with the lower part of the body.
  3. Bag (longitudinal) gastroplasty, This type of surgery used in the treatment of obesity, when you delete a large part of the stomach with preservation of the natural compounds of the duodenum and esophagus.
  4. Total resection of the stomach, when removed the entire organ, and then make a connection between the duodenum and the end part of the esophagus.

The main stages of the operation to remove stomach

Indications for surgical intervention

Absolute indication for resection are malignant tumors of the stomach, when the operation gives the patient a chance for life. Doctors prescribe surgery when long-term healing of ulcers, reduced gastric acidity, or experiences severe cicatricial changes that give a distinct clinical picture.

Stomach cancer

All the organs of the human body are composed of cells that grow and divide when new cells are needed. But sometimes this process is disturbed and begins to flow differently: the cells begin to divide when the body does not need and old cells do not die. There is an accumulation of extra cells forming the tissue, which doctors call a tumor or a neoplasm. They can be benign or malignant (cancerous).

Stomach cancer begins in the inner cells, but over time invades the deeper layers. In this case, the tumor can grow into adjacent organs: esophagus, intestines, pancreas, liver. Causes of malignant neoplasms of the stomach are divided into several types:

  • poor nutrition, especially associated with the abuse of fried, preserved, oily and spicy food;
  • Smoking and alcohol;
  • chronic diseases of the gastrointestinal tract: ulcer, gastritis;
  • genetic predisposition;
  • hormonal activity.

Severe stomach ulcers

Ulcer is called a defect of the gastric mucosa. Peptic ulcer disease is characterized by periodic exacerbations, especially in the spring and autumn period. The main reason for the development of the disease are frequent stress, strain the nervous system that causes muscle spasms in the gastrointestinal tract. As a result of this process fails in the nutrition of the stomach, and gastric juice has a devastating effect on the mucosa. Other factors leading to the development of peptic ulcer disease:

  • violated diet;
  • chronic gastritis;
  • genetic predisposition;
  • long-term use of medicines.

In chronic gastric ulcers occur in the mucosa of the body of the formation of ulcers. Resection of these abnormalities is performed when the development of complications of the disease, when there is no effect from conservative therapy, there is bleeding, the development of stenosis. This is the most traumatic type of surgery for stomach ulcers, but most effective.

Laparoscopic resection for obesity

Laparoscopic surgery is an endoscopic method of gastric surgery, which is performed through punctures in the abdominal cavity with a special tool without a wide incision. This resection is carried out with the least trauma to the patient, and the postoperative cosmetic result is much better. The indications for laparoscopic gastric resection is an extreme stage of obesity, when no meds, no strict diet of the patient does not help.

Obesity is a violation of metabolism, and when the process of losing weight can no longer operate, doctors had to remove part of the stomach, after which the patient gets rid of the problem, loses weight and gradually returning to everyday life. But the greatest advantage of laparoscopy is the restoration of normal metabolism, reducing the risk of atherosclerosis and coronary heart disease. Watch the video, how it’s performed laparoscopic resection of the stomach:

Surgical technique

Resection of the stomach is a technically complex process and to avoid postoperative inflammation, scarring, and other complications should be taken seriously to the selection of medical institutions and qualification of the surgeons. The choice of surgical technique depends on the degree of destruction of the body of the patient, his age, anatomical and other features. All the types of resection performed under General anesthesia and duration of surgery on the stomach not exceed three hours.

Basic ways of operation

There are many different variants of resection and reconstruction of the stomach. For the first time conducted a similar operation Theodor Billroth in 1881, and in 1885 he suggested another way of recovery of the gastrointestinal tract. These operations on the stomach used until now, but today they are modernized and simplified, and therefore available for a wide range of practicing surgeons. The type of surgery that the doctor selects individually in each case, but most often used:

  1. Subtotal distal resection when the lesion is located in pronounceing part of the lower third of the stomach (small curvature).
  2. Subtotal proximal resection, which is performed for cancer of the stomach 1 and 2 degrees when removed a small gland, lymph nodes, small curvature and the large omentum.
  3. Gastrectomy, which is performed in the presence of multiple primary tumors or with infiltrative cancer located in the middle section of the stomach. Removal shall be subject to the authority, and between the esophagus and the small intestine is imposed anastomosis.

The main methods of carrying out resection of the stomach

Billroth 1

Resection of the stomach Billroth 1 is the excision of 2/3 of the body, when the stored physiological way movement of food with the participation of the excreta of the pancreas and bile. During the surgical interference is connected anastomosis of the duodenum and stomach end to end. Use this method if there are polyps, malignant ulcers, small tumours antral gastric Department.

Billroth 2

Resection by Billroth 2 removed a large part of the dull stump of the duodenum and stomach, the front and rear of the anastomosis (the joining of two bodies). After this operation is impaired by a physiological path of movement of the food – it goes directly to jejunum, possibly throwing the bile and violation of the anastomosis. Resection by Billroth 2 has more testimony as it is performed on the stomach ulcers of any localization and cancer because it enables the Clinician to perform a wide removal of the organ up to 70 %.

The Comptroller-Finsterer

Methodology Hofmeister-Finsterer is a modified version of Billroth 2, which involves resection of not less than 2/3 of the body in peptic ulcer disease. During surgery, remove all of the secretory zone, whereupon the motor function of the stomach is undergoing significant changes: weakened peristalsis, the function of the goalkeeper, which provides for the gradual evacuation of food, generally falls.

At Ru

Method Ru is the removal of part of the body with V-neck gastroenteroanastomosis. In this case intersects the jejunum, and its distal end is sutured and connected with the lower third of the gastric stump. This is also a modification of the Billroth 2, which is shown in duodenogastric reflux esophagitis, which is characterized by reflux of duodenal contents into the stomach.

According To Balfour

The way Balfour is the imposition of the gastrointestinal connection on the long loop of the small intestine. This method prevents the pathological changes in the organs of the gastrointestinal tract, and also used at very high resection for peptic ulcer disease or inability binder other way because of the anatomical features of the stomach stump. Resection of the Balfour bridges the gap between the knees jejunum, eliminating the future occurrence of intestinal obstruction.

The scheme of the resection by Balfour

The rehabilitation process after surgery

As after any surgical intervention and after resection of the stomach there are all sorts of complications and the risk of development of negative symptoms: peritonitis, bleeding, anemia, reflux esophagitis, dumping syndrome. The average length of stay in hospital after surgery is 2 to 3 weeks and to sit the patient may already 5-6 days after resection. On doctor’s recommendations physical activity should be limited for some time, and within 4-6 months you need to wear a bandage. Complete restoration of function of the gastrointestinal tract occurs in 3-5 years.

Diet and nutrition after resection

After removing part of the stomach the diet should be corrected, because the food very quickly after resection comes from the esophagus into the small intestines, so food is not always going to happen a full absorption of nutrients. To avoid complications after surgery on the stomach to help following rules of supply:

  • eat up to 6 times a day;
  • eat slowly, chewing food thoroughly;
  • limit meals containing digestible carbohydrates: honey, sugar, jam;
  • tea, milk, kefir and other drinks should be consumed no earlier than 30 minutes after eating, so as not to overload the stomach;
  • special importance should be given to animal protein contained in chicken, eggs, fish, cheese, cottage cheese and vitamins contained in vegetables, fruits, berries, herbal teas.

In the first 3 months after resection of the need to place special emphasis on nutrition, because at this time is the adaptation of the digestive system to the new conditions of existence. At this time you need to eat mostly pureed or chopped foods are steamed. Recommended dishes: soups on vegetable broth, pureed milk porridge, vegetable soufflé, fruit puddings, steam omelets whole milk, sour cream sauces, weak coffee with cream and tea with milk.

Sample menu

In the first days after resection recommended:

  • 1 St day: complete fasting;
  • 2nd day: fruit jelly, unsweetened tea, mineral water without gas every 3 hours for 30 ml;
  • 3 and 4 days: soft-boiled egg, 100 ml of unsweetened tea, rice porridge, meat soup, broth hips, cheese souffle;
  • 5 and 6 days: scrambled eggs steam, tea with milk, mashed rice porridge, pureed rice soup, dumplings, meat steamed carrot puree, fruit jelly;
  • Day 7: liquid rice porridge, 2 boiled eggs, cheese souffle with no sugar, pureed vegetable soup, meat steam cutlets, fish fillet steamed, mashed potatoes, jelly, crackers of white bread.

Reviews about health after resection

Tatiana is 38 years old Voronezh, Russia:

After resection, when the background of the ulcer removed 2/3 of the stomach, I saved the children’s canned food, processed cooked beef and oat porridge. After 2 months, tried some vodka, and after 8 months became has all but limit salty and fried, because the examination found stones in the gallbladder. Life goes on!

Paul is 43 years old Ufa:

Three years ago, did a resection, removing the entire stomach and part of esophagus due to carcinoma. Then 3 chemistry passed, he lost 23 kg, I thought I’d die. After 4 months on the mend – I gained 10 kg, gradually began to eat everything, except fried – after it begins spasm of the esophagus. Given 2 disability group, and now I even found work as a watchman job.

Yuliya 27 years old Kursk, Russia:

In December of last year I had the resection of the whole stomach, and September just got married, children had planned. Almost a year has passed, I feel fine, if you do not eat fatty, fried, sour and sweet, but it’s hard for me, because before that loved to cook and tasty to eat. Doctors said children I can have, only later 5 years later when fully recovered all function of the gastrointestinal tract.

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