Operations on the stomach. Types of operations, indications, preparation and conduct
Every generation of people dictates their own rhythm. To get there in time, a modern person has to sleep less, refuse breakfast or lunch, snack on the run. All this negatively affects the condition of the stomach. A late visit to a doctor complicates the situation. If drug treatment is not able to cope with the problem, one must resort to radical measures. Such measures are operations on the stomach.
What is the stomach and what are its functions
Stomach is a special organ in the form of a hollow muscular sac intended for ingestion and digestion of food. This organ is located under the esophagus. Its lower part passes through the pyloric sphincter into the duodenum. An empty stomach has a volume within 0.5 liter. After eating, it increases to 1 liter, but can withstand overeating and stretch to 4 liters.
In addition to storing the food received, the functions of the stomach include:
- mechanical processing of the food mass;
- promoting food to the next intestinal tract;
- chemical effect on food by enzymes of gastric juice;
- isolation of elements that promote the absorption of vitamin B12;
- absorption of nutrients;
- disinfection of the food mass with hydrochloric acid;
- production of hormones.
In order to function smoothly, the body must be healthy. It is important to pay attention to changes in taste, heartburn, pain and nausea in time to avoid stomach surgery.
Common stomach diseases
Most often, doctors are treated with chronic gastritis, duodenitis, erosion, ulcers and oncological neoplasms. Each disease is more or less dangerous and requires qualified treatment. The patient must fully fulfill the doctor's prescriptions and follow all the recommendations so that he does not have to visit the operating unit.
Types of operations. Resection of
In medical practice with stomach diseases several types of surgical interventions are used. This is a resection, gastrectomy, gastroenterostomy, vagotomy. Each operation has its own indications and contraindications and requires a certain skill from the surgeon.
The resection of the stomach is called the removal of some part of the organ with the subsequent restoration of the continuity of the esophageal tube. Similar operations on the stomach are prescribed for cancers, ulcers or high degree of obesity. The operation requires a comprehensive diagnosis and a certain preparation of the patient. In addition, the development of postoperative complications is possible.
Depending on the complexity of the disease, the doctor selects the type of resection. It can be:
- Complete removal of the stomach.
- Removal of part of the organ near the esophagus, that is, proximal resection.
- Removal of the lower organ sector in front of the duodenum, that is, distal resection.
- Sleeve removal for obesity.
The proximal and distal operation is most often performed. Resection of the stomach in this case involves stitching the organ stump to the esophagus( proximal) or the small intestine( distal).Similar resections are occupied by a specialist for more than 2 hours.
Resection for gastric ulcer
Most often the stomach ulcer can be cured outpatiently. But sometimes the drug treatment does not give a result. Operation with an ulcer is prescribed in the following cases:
- When the scar is narrowing the pyloric sphincter( pyloric stenosis).
- With the spread of pathology beyond the stomach( peneration).
- When perforating( the appearance of a through hole).
- With advanced form of ulcers with large size and large depth of tissue damage.
In addition, stomach surgeries can be prescribed if the patient has had a bleeding that can not be treated medically. The reason for resection can serve as frequent relapses of the disease.
Resection for oncological neoplasm
Gastroenterologists and oncologists are often treated by patients with cancerous tumors. Gastric cancer is considered the most common form of cancer. Surgery for stomach cancer may require partial removal of the organ rather than partial resection. This operation is called gastrectomy. Formally, this is a type of resection, but the manipulation is more complex, and the negative impact on the patient is more pronounced.
With gastrectomy, not only the stomach is removed, but also two omentum and lymph nodes. Complete removal of the stomach suggests a direct connection of the esophagus with the jejunum. An artificial joint( anastomosis) is performed by a two-row intestinal suture.
After the operation, chemical and mechanical processing of food is not performed. This requires strict adherence to diet and a uniform distribution of meals throughout the day. Portions should be small, from the menu completely eliminated complex fats and digestible food.
With a full gastrectomy, the laparoscopic method is almost not used. A traditional open technique is used, in which a large cut is performed. The patient needs several weeks to recover from surgery. After awakening from anesthesia, the patient does not drink or eat. He is put a urinary catheter and nasogastric tube, sometimes breathing occurs through the mask.
The patient begins to give water only after the appearance of peristaltic sounds. If the body normally responds to the liquid, then start to give soft foods.
Resection for obesity
With a high degree of obesity, in some cases, a longitudinal resection is prescribed. Sometimes the procedure is called a sleeve removal. The operation cuts off most of the stomach, but retains physiological valves. As a result, the volume of the organ decreases, but the process of digestion is not disturbed. The stomach is no longer like a muscle bag, it looks like a narrow tube, the volume of which is about 150 ml. There is a dramatic decrease in weight and a decrease in the feeling of hunger, as the zone that produces the hormone responsible for this feeling is removed. Longitudinal resection allows you to lose up to 60% of excess weight, while in the stomach do not place foreign objects, such as a balloon or bandage. This method of treating obesity can be used at any age.
Gastroenterostomy
It is not possible to perform gastrectomy with certain indications. This applies to elderly people, weak patients, cases of cicatricial stenosis as a result of stomach burn and inoperable cases of oncological diseases. Such patients are given gastroenterostomy. During the operation, an ankle is formed between the cavity of the stomach and the small intestine.
The operation helps to relieve the stomach, accelerate the evacuation of food and restore patency. However, it gives a lot of complications, so it is performed only in the absence of other treatment options.
Vagotomy
Another method of treating gastric ulcers is vagotomy. This is an operation involving the dissection of the vagus nerve. As a result of manipulation, the nerve impulses on which the production of gastric juice depends depend. The gastric content decreases acidity, resulting in the healing of ulcers.
For the first time in the operating unit, a patient was delivered to carry out vagotomy in 1911.The report was made at the Berlin Surgical Congress. Since 1946, the operation has been put on stream.
Since 1993, the amount of vagotomy has declined sharply, as preparations blocking the production of acid have become widely used.
Cost of operation
The cost of the same manipulation in different countries, and even in the regions of one country can vary significantly. Everything depends on the complexity of the disease, the location of the pathology, the qualification of the surgeon or oncologist, as well as the technical equipment of the clinic. All questions are resolved during a consultation with specialists. Most often, the cost of surgery includes hospital stay, anesthesia and post-operative care.
In recent years, people who have serious problems with obesity, resort to the help of surgeons. To cope with excess weight the operation of longitudinal resection of the stomach allows. Its average cost in Russia is about 140,000 rubles.