Laparoscopic Gastrectomy

What you should know

• Laparoscopic gastrectomy is a newer type of less invasive surgery done to treat early stomach cancers. A gastrectomy is surgery to remove a part or all of your stomach. The stomach is a hollow organ that breaks down food into nutrients (small pieces your body can take in). It absorbs (takes in) some of these nutrients and the rest then pass into your small intestine (bowel). Your stomach is connected to your mouth by a tube called the esophagus. This surgery is used for stomach cancer that is found early and is still small in size. You may have cancer in the upper or lower part of your stomach, or both. Your caregiver will do surgery that is tailored to the location and size of your cancer.
  
  
• Stomach cancer happens when abnormal cells in your stomach grow and become tumors. Cancer cells may break off from the tumors and spread to other parts of your body, such as your lymph nodes. Laparoscopic gastrectomy is done using special tools put into small incisions (cuts) made in your abdomen (belly). The laparoscope is a long metal tool with a tiny video camera and light at the tip. Your caregivers can see your stomach and other parts inside your abdomen by watching on a video screen. Caregivers use other special tools to cut and remove the stomach tumors and other tissues inside your abdomen. After surgery you should have less pain and faster healing compared to having an open (large incision) gastrectomy. Laparoscopic gastrectomy may be all the treatment you need to make your early stomach cancer go away.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• The air put into your abdomen may cause shoulder or chest pain for several days after your surgery. After your surgery, you may have pain or feel full even after eating small amounts of food. Without some parts of your stomach, you may not get all the nutrients you need from your food. Your caregivers may find during your surgery that they cannot do, or complete the procedure as they planned. Your surgery would then become an open (large incision) gastrectomy. During surgery you may have an allergic reaction to the anesthesia medicine and have trouble breathing. You could bleed more than expected, or get an infection in your lungs or wounds. You may have leaking of stomach or bowel contents from your incisions and get a life-threatening infection. Even after surgery, tumors may return in your remaining stomach or in nearby organs and tissues.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• Your chances of stopping your cancer from spreading are better if you are treated early in the disease. If you do not have surgery, your stomach tumors will continue to get bigger and cause problems. They may block your stomach or bowel, and prevent you from being able to eat. Tumors may press on and pinch nearby tissues and organs to cause pain and injury. Cancer cells may also spread to other body parts, grow into new tumors, and cause more damage. Call your caregiver if you are worried or have questions about your surgery, medicines, or care.

Getting Ready

The week before your surgery:

• You may need to have your blood and urine tested. Imaging tests, such as x-rays, computerized tomography (CT) scan, endoscopy, or endoscopic ultrasound may be done. A biopsy may also be done to get tissue samples of your tumor. These are sent to a lab for tests to check for cancer. Ask your caregiver for more information on other tests that you may need. Write down the date, time, and location of each test.
  
  

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

• You will be asked to change into a hospital gown. You may be given antibiotic medicine through your IV to prevent an infection. You will be taken on a stretcher to the operating room. Anesthesia medicine will be given to control pain during your surgery. You will lie on your back during the surgery. Your chest and abdomen will be cleaned and then covered with sheets. Your caregiver may insert an endoscope through your mouth down to your stomach. It is a long flexible tool with lights and a video camera at the tip. Caregivers use the endoscope to look at the inside of your stomach to find your tumors.
  
  
• Your caregivers will make 3 to 5 small incisions (cuts) for the laparoscopes and other special tools to pass through. They may also make an incision in your abdomen large enough for a hand to be passed through. With this incision, a caregiver's hand can work along with the tools during the surgery. Your abdomen may be filled with air to lift the abdominal wall to let your stomach be seen. Depending on your condition, your caregiver will remove your whole stomach or leave a part of it. He will connect your esophagus or your remaining stomach to your small intestine (bowel). A drain (thin tube) may be placed to empty fluid or blood from inside your abdomen. The incisions will be closed with sutures (stitches) and covered with a bandage.

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 try to get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken to your hospital room. The bandages covering your incisions will keep the area clean and dry to prevent infection. A caregiver will remove the bandages soon after your surgery to check your wound.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your surgery on time.
  
  
• You get sick (a cold or flu), or have a fever.
  
  
• You have a wound or skin infection near the area where your surgery will be done.

Seek Care Immediately if

• You are throwing up blood.
  
  
• You have severe (very bad) pain in your abdomen, or feel faint or weak.
  
  
• You have trouble breathing or chest pain all of a sudden.
  
  
• You throw up after having small amounts of food or liquids.

Learn more about Laparoscopic Gastrectomy (Precare)