Gastrectomy

WHAT YOU SHOULD KNOW:

• A gastrectomy is surgery to remove part or all of your stomach when you have cancer in it. The stomach is a hollow organ that breaks down food into nutrients (small pieces your body can take in). Your stomach absorbs (takes in) some nutrients and the rest then pass into your small intestine (bowel). Your stomach is connected to your mouth by a tube called the esophagus. You can get cancer in the upper or lower part of your stomach, or in all of it. Your caregiver will do a partial or total gastrectomy that is tailored to the location of your cancer. The path food travels may be changed with surgery, such as going from your esophagus into your bowel. Surgery may be done to remove the cancer, decrease pain and allow you to eat better, or both.
  
  
• Stomach cancer happens when abnormal cells grow and form one or more tumors in your stomach. The tumors can pinch blood vessels and nerves, and press on and damage nearby tissues. Cancer cells may break off from the stomach tumor and travel to other organs or body parts. Your surgery may also remove all or parts of nearby organs and tissues. These include your esophagus, lymph nodes, small intestine, spleen, pancreas, liver, and colon (large intestine). Caregivers may only remove tumors that give you severe (very bad) problems and leave other tumors behind. Your cancer problems, such as pain, bleeding, or weight loss, may or may not get better after surgery. Even when tumors are removed, they may come back or spread to other parts of your body.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• You may have an allergic reaction to the anesthesia medicine, and have trouble breathing. You could bleed more than expected, get blood clots, pneumonia, or an infection. Incisions inside your body may not heal quickly, and food and liquids may leak out inside your abdomen. Without part or the whole of your stomach, you may not get enough nutrients from food. You may feel full after eating only small amounts of food. You may get dumping syndrome (loose watery stools that come soon after you eat) following your surgery. Even after surgery, tumors may return in your remaining stomach or to nearby organs and tissues. You may still get life-threatening bleeding or an infection and die.
  
  
• If you do not have this surgery, you likely will continue to have pain and lose weight. You may have eating problems, such as throwing up and feel full after eating small amounts of food. As the tumor gets larger, you may get a blockage that causes you to throw up all food. Your cancer can cause your stomach or nearby blood vessels to bleed so that you lose a lot of blood. Losing a lot of blood may cause you to have infections, breathing problems, or even die. Cancer cells can spread to other parts of your body, and grow into new tumors and cause damage. Cancer cells may reach your liver, and make it swell and cause you to have yellowish skin. Call your caregiver if you are worried or have questions about your surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.
  
  
• Nasogastric (NG) tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty. You may need a NG tube if your stomach gets too full or if you throw up a lot after surgery. You may also need it if you cannot use your mouth to eat. An NG tube may also be used to help get your bowels working. Food or medicine may be given through your NG tube.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

During your surgery: An incision (cut) is made on your abdomen (belly) to reach your stomach. Your caregiver carefully cuts through or pushes aside muscles and other tissues until your stomach is seen. Depending on your condition, your caregiver may remove the whole stomach, or leave a part of it. Sometimes he may only remove the tumor and a large part of tissue surrounding it. He connects your esophagus or the remaining stomach to your small intestine (bowel). He checks around for other damages and tumors which may have spread nearby, and stop any bleeding. A drain ( thin tube) may be placed to empty the fluid or blood from your abdomen. The incision is closed with sutures (stitches) or staples and covered with bandages.

After your surgery: You may be taken to a recovery room, where you will stay until you are fully awake. Caregivers will watch you closely for problems. Do not attempt to get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages covering your incision keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wound.

• Activity: Caregivers may help you get out of bed to walk on the same day of surgery, or the day after. Ask caregivers if there are exercises that you may do while in bed. Exercise helps blood move through your body and may help prevent blood clots from forming. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy while standing up, sit or lie down right away and call your caregiver.
  
  
• Deep breathing and coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.
  
  
  • Hold a pillow tightly against your incision (cut) when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
    
    
  • You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.
  
  
• Medicines: Your caregiver may give you the following kinds of medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Pain medicines: These types of medicines are given to decrease your pain after your surgery. You may need any of the following:
    
    
    • Medicines for pain, swelling, or fever: You may be given medicines to treat pain, swelling, or fever while you are in the hospital. These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease, a history of bleeding in your stomach, or any other medical problems. Also tell your caregiver about any allergies you have to medicines. Tell your caregiver about all other medicines, herbs, and supplements that you have taken lately.
      
      
    • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
      
      
    • Patient controlled analgesia: You may get pain medicine from a special pump. You can receive the pain medicine through an IV or an epidural line. This is called patient controlled analgesia (PCA) or patient controlled epidural analgesia (PCEA). Your caregivers set up the PCA pump to give you small amounts of pain medicine. The PCA pump has a cord coming from it, with a push button on the end. When you feel pain and push the button, you will give yourself pain medicine. To keep you from getting too much medicine, there is a limit on how often you can get the medicine. Do not let anyone else push the button for you. Your pump may give you a constant dose of pain medicine, as well as the medicine that you give yourself. If your pain is still bad even with using the PCA, let your caregivers know.
  
  
• Monitoring: Caregivers may check for pulses on your arms or wrists. This helps caregivers learn if you have problems with blood flow after your surgery. You may also have any of the following:
  
  
  • Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
    
    
  • Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
    
    
  • Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
    
    
  • Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Link to Page

Print Page

Email Page