Laparoscopic Antrectomy – Find Procedure, Test, Tube Removal and Cost Estimate
An antrectomy is the resection, or surgical removal, of a part of the stomach known as the antrum. The antrum is the lower third of the stomach that lies between the body of the stomach and the pyloric canal, which empties into the first part of the small intestine. It is also known as the antrum pyloricum or the gastric antrum. Because an antrectomy is the removal of a portion of the stomach, it is sometimes called a partial or subtotal gastrectomy .
An antrectomy may be performed to treat several different disorders that affect the digestive system:
Peptic ulcer disease (PUD). An antrectomy may be done to treat complications from ulcers that have not responded to medical treatment. These complications include uncontrolled or recurrent bleeding and obstructions that prevent food from passing into the small intestine. Because the antrum produces gastrin, which is a hormone that stimulates the production of stomach acid, its removal lowers the level of acid secretions in the stomach.Cancers of the digestive tract and nearby organs. An antrectomy may be performed not only to remove a malignant gastric ulcer, but also to relieve pressure on the lower end of the stomach caused by cancers of the pancreas, gallbladder, or liver.
Arteriovenous malformations (AVMs) of the stomach. AVMs are collections of small blood vessels that may develop in various parts of the digestive system. AVMs can cause bleeding into the gastrointestinal tract, resulting in hematemesis (vomiting blood) or melena (black or tarry stools containing blood). The type of AVM most likely to occur in the antrum is known as gastric antral vascular ectasia (GAVE) syndrome. The dilated blood vessels in GAVE produce reddish streaks on the wall of the antrum that look like the stripes on a watermelon.
Gastric outlet obstruction (GOO). GOO is not a single disease or disorder but a condition in which the stomach cannot empty because the pylorus is blocked. In about 37% of cases, the cause of the obstruction is be nign—most often PUD, gallstones, bezoars, or scarring caused by ingestion of hydrochloric acid or other caustic substance. The other 63% of cases are caused by pancreatic cancer, gastric cancer, or other malignancy that has spread to the digestive tract.Penetrating gunshot or stab wounds that have caused severe damage to the duodenum and pancreas. An antrectomy may be done as an emergency measure when the blood vessels supplying the duodenum have been destroyed.
Diagnosis of PUD and other stomach disorders begins with taking the patient’s history, including a family history. In many cases the patient’s primary care physician will order tests in order to narrow the diagnosis. If the patient is older or has lost a large amount of weight recently, the doctor will consider the possibility of gastric cancer. If there is a history of duodenal or gastric ulcers in the patient’s family, the doctor may ask questions about the type of discomfort the patient is experiencing. Pain associated with duodenal ulcers often occurs at night, is relieved at mealtimes, but reappears two to three hours after eating. Pain from gastric ulcers, on the other hand, may be made worse by eating and accompanied by nausea and vomiting. Vomiting that occurs repeatedly shortly after eating suggests a gastric obstruction.
The most common diagnostic tests for stomach disorders are:
Endoscopy. An endoscope is a thin flexible tube with a light source and video camera on one end that can be passed through the mouth and throat in order to look at the inside of the upper digestive tract. The video camera attached to the endoscope projects images on a computer screen that allow the doctor to see ulcers, tissue growths, and other possible problems. The endoscope can be used to collect tissue cells for a cytology analysis, or a small tissue sample for a biopsy. A tissue biopsy can be used to test for the presence of Helicobacter pylori , a spiral bacterium that was discovered in 1982 to be the underlying cause of most gastric ulcers, as well as to test for cancer. Endoscopy is one of the most effective tests for diagnosing AVMs.
Double-contrast barium x-ray study of the upper gastrointestinal tract. This test is sometimes called an upper GI series. The patient is given a liquid form of barium to take by mouth. The barium coats the tissues lining the esophagus, stomach, and small intestine, allowing them to be seen more clearly on an x ray. The radiologist can also watch the barium as it moves through the digestive system in order to pinpoint the location of blockages.
Urease breath test. This test can be used to monitor the effects of ulcer treatment as well as to diagnose the presence of H. pylori . The patient is given urea labeled with either carbon 13-C or 14-C. H. pylori produces urease, which will break down the urea in the test dose to ammonia and carbon dioxide containing the labeled carbon. The carbon dioxide containing the labeled carbon can then be detected in the patient’s breath.
Preparation for an antrectomy requires tests to evaluate the patient’s overall health and fitness for surgery. These tests include an EKG, x rays, blood tests, and a urine test. The patient is asked to discontinue aspirin and other blood-thinning medications about a week before surgery. No solid food or liquid should be taken after midnight of the evening before surgery.
In most hospitals the patient will be given a sedative before the operation either intravenously or by injection. The general anesthesia is given in the operating room .
In addition to early or late dumping syndrome, other risks associated with antrectomies include:
Diarrhea. This complication is more likely to occur in patients who had a vagotomy as well as an antrectomy.
Weight loss. About 30–60% of patients who have had a combined antrectomy/vagotomy lose weight after surgery. The most common cause of weight loss is reduced food intake due to the smaller size of the stomach. In some cases, however, the patient loses weight because the nutrients in the food are not being absorbed by the body.
Malabsorption/malnutrition. Iron-deficiency anemia, folate deficiency, and loss of calcium sometimes occur after an antrectomy because gastric acid is necessary for iron to be absorbed from food.
Dysphagia. Dysphagia, or discomfort in swallowing, may occur after an antrectomy when digestive juices from the duodenum flow upward into the esophagus and irritate its lining.
Recurrence of gastric ulcers.
Bezoar formation. Bezoars are collections of foreign material (usually vegetable fibers or hair) in the stomach that can block the passage of food into the small intestine. They may develop after an antrectomy if the patient is eating foods high in plant fiber or is not chewing them thoroughly
Normal Results :
Normal results of an antrectomy depend on the reasons for the surgery. Antrectomies performed to reduce acid secretion in PUD or to remove premalignant tissue to prevent gastric cancer are over 95% successful. The success rate is even higher in treating watermelon stomach. Antrectomies performed to treat gastric cancer or penetrating abdominal trauma are less successful, but this result is related to the severity of the patient’s illness or injury rather than the surgical procedure itself.
Antrectomy (distal gastrectomy) is a procedure in which the distal third of the stomach (the gastric or pyloric antrum) is excised.
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