Gastric surgery (gastrectomy) may be performed for various reasons, sometimes for benign disease (ulcer disease, benign gastric tumors, bleeding, perforation, etc.) and sometimes for cancer of the stomach or lower esophagus.
The operations themselves are very similar, but the work-up and follow-up may be quite different. Most gastric surgery is done as an elective procedure and you will stay in the hospital for 2-3 days after the operation. Sometimes emergency gastric surgery is needed, usually if there is a perforation, or hole, in the stomach or for severe bleeding from the stomach. For these types of surgery, recovery time is usually longer and other problems like infection and injury to other body systems is more common.
Regardless of disease requiring gastric surgery, gastrectomy can be performed laparoscopically or as an open operation. Most gastric surgery is done as an elective procedure and requires you to stay in the hospital 1-2 days. You may have an x-ray swallowing study done the morning after surgery. If the study is okay, you will be started on a liquid diet before being sent home. You will have specific diet restrictions after gastric surgery and will be given instructions on how to advance your diet at home.
Preoperative Information
Prior to gastric surgery, you will be asked not to eat anything after midnight prior
to your surgery. You will be given specific instructions from your surgeon or anesthesiologist
about which medications you should or should not take prior to your surgery. You should
not take any blood thinning medications, such as aspirin, Ibuprofen, Coumadin, Plavix,
or goody's powder at least 5 days prior to your operation. This should be discussed
with your surgeon at your preop visit..
Your work up before having gastric surgery will include an upper endoscopy to look directly at the upper digestive tract and take any biopsies, if necessary. A swallowing study (x-ray study) is also needed to evaluate the anatomy and function of the upper digestive tract.
If there is a concern for a tumor within the gastric wall, endoscopic ultrasound of the area will be performed to assess the depth or thickness of the tumor and provide your doctors with information about lymph nodes close to the area. This is done by a Gastroenterologist, a physician specializing in gastrointestinal disease and endoscopy. If there is concern for a malignancy (cancer), a CT scan will be obtained to see if the cancer has spread to any other areas of the body, like the liver or lungs
You will also have a detailed discussion with your surgeon about the risks and benefits
of gastric surgery, including the possibility that your symptoms will not get.
If you are having surgery to improve gastric motility (gastroparesis), you will also
need to have a gastric emptying study. This a study performed in the nuclear medicine
department, a section of radiology, and tests how quickly and completely your stomach
empties.
Postoperative Information
Gastric surgery is often performed laparoscopically. In this case, you will stay in
the hospital overnight and likely be discharged 1-3 days after surgery.
In the event that you require an open gastric surgery, you may have to stay in the hospital a little longer for pain control, though not in all cases.
You may have a swallowing study done the morning after surgery. This is to make sure there is no leak from the stomach surgery. If the swallow study is normal, you will be given a liquid diet and you will start preparing to go home the next day.
Activity
You can resume most usual activities gradually beginning shortly after surgery. You
should begin walking the night of surgery or the following morning and continue to
increase as you are able. Increased activity reduces the risk of blood clots, and
improves breathing to prevent pneumonia
While in the hospital, you will be asked to walk several times a day, beginning no later than the morning after surgery in most cases. You will usually need assistance to get out of bed, especially the first time, since you will likely have IV tubing and sometimes drains or catheters that need to be disconnected in order for you to get around.
After discharge from the hospital, avoid lifting more than 10 pounds for 2-4 weeks and excessive bending or twisting for 1-2 weeks following surgery. This is to allow healing of the incisions, specifically the fascia (the strongest layer of the abdomen wall) and decrease the risk of a hernia developing. For laparoscopic surgery there may be less risk for developing a hernia and it may be safe to return to unrestricted activity sooner.
Avoid driving until you no longer need narcotic pain medication and you feel you can make rapid movements unimpaired by pain. Driving while taking narcotics can impair your ability to drive safely.
You should be able to return to work in 1-3 weeks. If your job involves heavy lifting and light duty is not an option, you may need up to 4 weeks off work to recover
Wound Care
If your gastric surgery was done laparoscopically, small gauze and clear tape dressings
or a small white dressing is typically placed over each incision. These dressings
may be removed 48 hours (2 days) after the operation. If you are in the hospital more
than one day, these may be removed before you leave the hospital. Below this dressing
are small brown or white pieces of tape (called Steri-Strips); these will fall off
on their own within 1-2 weeks or be removed at your follow-up visit with your surgeon.
If your surgeon gives you specific instructions other than this, please follow those
instructions.
If your gastric surgery was done as an open procedure, you will probably have a long white dressing or gauze and tape dressing over your incision. This dressing may be removed 48 hours (2 days) after the operation and will probably be removed before you leave the hospital. Your incision will probably be closed with small metal staples. These will be removed at your postop visit, usually 10-14 days after your operation. If you are in the hospital more than a week, these may be removed before you go home.
You may shower after 48hrs (after the gauze and clear tape dressing is removed). It is okay to get soap and water on the incisions. Pat the area dry. You will be able to shower in the hospital after 48hrs as well. Your nursing staff can assist you if needed. It is not recommend that you submerge underwater (in a bathtub, pool, or hot-tub) for at least two weeks post-op.
If you notice drainage from your incisions, particularly if it is thick and foul-smelling or associated with a fever, contact your surgeon.
If you notice redness around your incisions, especially if it is getting worse or associated with drainage or a fever, contact your surgeon.
Medications - Pain Management
If your gastric surgery is performed laparoscopically, pain is typically just around
the site of incisions. However, you may have more general abdominal pain or even shoulder
pain due to the air used to inflate your abdomen during the surgery. Pain from air
inflation will go away in 24 to 48 hours.
Pain after a large open operation can be significant. You will most likely be placed on IV narcotics using a pump (PCA � patient controlled analgesia), which allows you to press a button for additional medication when you need it. This will be weaned off within a few days of your operation and you will start oral pain medications. It is very important to us that your pain be well controlled. Your pain should be controlled well enough for you to begin getting out of bed the morning after surgery and for you to perform deep breathing exercises. If you have pain that is not well enough controlled to allow you to walk or breathe deeply, talk to your surgery team. You may need to have your pain medications changed or increased.
You will be discharged with pain medication, typically a mild to moderate strength narcotic. Take as needed and as prescribed. You may also take over-the-counter medications such as Advil for pain. Most narcotic medications prescribed are combined with Tylenol (acetaminophen). You should not take additional Tylenol if you are taking a narcotic medication that already contains Tylenol.
Nausea
It is very important to control any nausea you might experience after your surgery.
You will have access to IV anti-nausea medication throughout your hospital stay. Oral
anti-nausea medication or rectal suppositories that can control nausea will be prescribed
as needed upon hospital discharge. Please let your surgeon know if you develop nausea
after discharge so that he or she can address this further.
Other Medications
You may be prescribed a stool softener when you go home. Pain medications can cause
constipation and a stool softener may help. You may also be given nausea medication
if you have experienced nausea or vomiting from taking your pain medication.
Home Medications
Unless otherwise instructed, you should be able to resume your usual home medications
the night of or the morning following your surgery.
Click here for more detailed information on commonly prescribed medications.
Diet & Bowel Care
Following gastric surgery, you will be given specific diet instructions and be seen
by a nutritionist.
Many patients will notice their stomach feels very full quickly and have bloating after having gastric surgery. Eating smaller meals, separating intake of solids and liquids, and avoid foods or drinks that you know make you gassy (such as carbonated beverages, alcohol, some vegetables) will help with these symptoms. You may also need to take nausea medication prescribed by your doctor. This usually gets better within a few weeks after surgery when the swelling of the stomach wrap goes down.
Some patients may also have diarrhea and cramping (called dumping syndrome) if they do not eat the right foods, and do not separate solids and liquids when they eat. See diet after gastric surgery for more details.
It is common to have some constipation after surgery, especially when taking narcotic pain medications. You will probably be prescribed a stool softener when you are discharged. If you are having trouble moving your bowels after surgery (if your stool is hard or you have to strain excessively) you may need a laxative. Over the counter medications can treat this well. Senna, Miralax, or dulcolax are some of the most common and are available at most drug stores or grocery stores. Take as directed.
If you experience problems having a bowel movement AND have abdominal bloating, nausea or vomiting, and not passing gas, call your doctor.
Follow Up
You will be given a date and time to see your surgeon following surgery. If you are
discharged late in the day or over the weekend, you will be given a number to call
the following business day for an appointment. If you are having trouble making an
appointment, call your doctors' office directly for assistance.
Call Your Doctor If:
Contact Information
Daytime hours: Call 706-721-4686 or 7597
After hours and weekends: Call 706-721-8400