Total Gastrectomy

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Linitis plastica
  • Carcinoma of the proximal (upper third) stomach
  • Lymphosarcoma
  • Sarcomatous degeneration of multiple leiomyomas
  • Complicated lymphoma of the stomach that cannot be treated with chemotherapy plus radiotherapy
  • Palliation
CONTRAINDICATIONS
  • Ascites (relative)
  • Unless it is the only palliative option in the presence of
    • Peritoneal disease
    • Hepatic metastases
    • Diffuse nodal metastases
EQUIPMENT
  • Anesthetic equipment
  • Operating table
  • Instrument table
  • Electrocautery device
ANATOMY
  • Cardia: Connects the proximal stomach to the distal esophagus.
  • Pylorus: Connects the distal stomach to the proximal duodenum.
  • The stomach is fixed at the gastroesophageal junction and the pylorus; its large midportion is mobile.
  • From proximal to distal, the stomach is divided in three regions: fundus, corpus and antrum.
  • Inferiorly, the stomach is attached to the transverse colon, spleen, caudate lobe of the liver, diaphragmatic crura, and retroperitoneal nerves and vessels. The gastrosplenic ligament attaches the proximal greater curvature to the spleen.
  • Most of the blood supply to the stomach is from the celiac artery. There are four main arteries: the left and right gastric arteries along the lesser curvature and the left and right gastroepiploic arteries along the greater curvature. The veins of the stomach parallel the arteries.
  • The lymphatic drainage of the stomach parallels the vasculature and drains into four zones of lymph nodes. All four zones of lymph nodes drain into the celiac group and into the thoracic duct. Gastric cancers may metastasize to any of the four nodal groups regardless of the cancer location.
  • The extrinsic innervation of the stomach is both parasympathetic through the vagus and sympathetic through the celiac plexus.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Pain control using intravenous analgesics.
  • Progressive increase in activity.
  • Gastrografin/barium swallow study at postoperative day 5. If the swallow study results are OK, start clear liquid diet.
  • Removal of dressing in 2 days.
  • Avoid soaking the wound under water for 1 week.
  • Avoid lifting more than 10 lb for 4 weeks.
COMPLICATIONS
  • Dumping syndrome
  • Anastomotic leak
  • Anastomotic narrowing or obstruction
  • Jejunoesophageal reflux
  • Alkaline reflux esophagitis
  • Recurrent tumor
  • Esophageal strictures
  • Small-bowel obstruction
  • Afferent loop obstruction
RESULT ANALYSIS
  • Long-term survival after curative resection remains stage dependent. In patients with R0 resection and 15 nodes sampled, current 5-year survival rates are 54% for T3N0, 38% for T3N1, 13% for T3N2, 53% for T2N1, and 84% for T2N0.
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