Gastric Resection
Objective
To remove the stomach (Partial or Total) in case of:
• Gastric ulcer; elective
or emergency
• Trauma
• As part of other
operations, e.g. pancreaticoduodesectomy.
Position
Supine - Midline incision.
Anesthesia
General.
Principles
a. For ulcer disease 60-70%
of the stomach is resected. The left gastric artery is ligated on the stomach.
Omentum is not resected.
b. For distal gastric
cancers, the left gastric artery is ligated at its origin but short gastric
arteries are preserved and 80% of stomach is resected.
c. For gastric cancers involving
the body or cardia, the entire stomach is resected with or the entire omentum.
The left gastric artery is ligated at its origin and all short gastric arteries
are ligated. The spleen may be removed in continuity to increase the radicality
of the operation but is controversial. In b and c all draining lymph nodes are
removed.
Procedure
1. The stomach is mobilized
after ligating the right gastric and gastroepiploic vessels at their origin.
2. The duodenum is mobilized
off the pancreas and divided.
3. The distal end of the
duodenum is closed in layers or stapled.
4. The
stomach is turned back to identify the left gastric artery is divided between
ligatures.
5. The
stomach is resected and a gastrojejunostomy is fashioned.
6. If
a total gastrectomy is performed, then an esophago-jejunal “roux-en-y”
anastomosis is done.
7. The
wound is closed in layers after draining the area of the duodenal stump.
Instruments
• General
set, 1
• Gastrointestinal
set, 1.
ANY question be sent to drmmkapur@gmail.com
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