How long does it take to recover from a total gastrectomy

If you have stomach cancer, your doctor may suggest taking out part or all of your stomach. Although this will change how you digest food, you’ll still be able to eat and drink. The surgery can also stop your cancer from spreading and prevent it from coming back.

It’s often part of the treatment for stomach cancer. Depending on where the cancer is in your stomach and how far it has spread, your surgeon will decide what type of treatment you need.

A total gastrectomy means the doctor will remove your entire stomach. Sometimes they only need to take out part of your stomach. They’ll call this subtotal, or partial, gastrectomy.

Even if they can’t remove all of the cancer, a partial gastrectomy may provide some relief. It isn’t a cure, but it can ease symptoms like pain and bleeding.

Your doctor will look at the type and stage of your cancer as well as any other health problems you have. Some, like anemia and hypoproteinemia (low protein levels in your blood), make it more likely you’ll have severe problems after this surgery.

You’ll need to go to the hospital for a gastrectomy. It can take between 4 to 5 hours if the doctor makes a large incision (a cut) to remove your stomach. Or they can make several small cuts, called laparoscopic gastrectomy. It takes less time, but it isn’t as widely used.

First, you’ll get anesthesia so you sleep through the procedure. Once you’re under, a surgeon will make an incision in your belly. Through this, they’ll remove part or all of your stomach, as well as some nearby tissue like your lymph nodes. They’ll test the nodes to make sure the cancer hasn’t spread. It’s key that your doctor remove as much of the cancer as they can.

Depending on the type of procedure you have, the surgeon will decide the best way to rebuild your digestive tract.

This is major surgery, so it’ll take some time for you to feel better. Your hospital stay will depend on the type of gastrectomy performed.

For the first few days, you won’t be able to eat any food. Then you’ll be on a clear liquid diet. This gives your digestive tract a chance to heal. Instead, you’ll be fed through an IV in your vein or a catheter (tube) that goes into your belly. After about a week, you should be ready to start a light diet again.

Because your stomach is smaller now, be prepared to make some changes to how you eat:

Small meals throughout the day. Six small meals will be easier for you to digest than three large ones.

Drink and eat at different times. Have fluids 1 hour before or after meals instead of during them.

Watch your fiber intake. High-fiber foods like beans, lentils, and whole grains can fill you up too fast. Add them back slowly.

Go easy on dairy. After this surgery, many people can’t digest lactose, the sugar in milk. If you’re one of them, you’ll have gas, bloating, and diarrhea after you have dairy foods.

Take a supplement. Some nutrients like iron, calcium, and vitamins B12 and D are harder for your body to absorb from food after a gastrectomy. Your doctor may do blood tests to check these levels. If they’re low, you may need to start taking a supplement.

You could get what’s called dumping syndrome. When your small intestine has to digest a large amount of food at once, you may throw up or have nausea, cramps, or diarrhea. Many people notice these symptoms within an hour of eating.

If you feel sick a few hours later, your blood sugar may be rising and falling too fast. It’s common to sweat, have a fast heart rate, or feel tired or confused.

Changing what you eat can help you manage these symptoms. Remember, too, to be patient. After your gastrectomy, it may take 3 to 6 months to adjust.

How is a partial gastrectomy performed?

A partial gastrectomy is usually performed with the patient under general anesthesia by a gastrointestinal surgeon. The surgery is performed in an operation theater, and may take up to five hours and require up to two weeks of recovery in the hospital.

A partial gastrectomy is usually performed with the patient under general anesthesia by a gastrointestinal surgeon. The surgery is performed in an operation theater, and may take up to five hours.

Preparation

Prior to a partial gastrectomy, a patient may be required to

Undergo urine, blood and imaging tests.
Undergo corrective treatment for any existing conditions that preclude surgery.
Undergo an upper gastrointestinal endoscopy.

The patient must

Avoid eating or drinking for 8 hours prior to the surgery.
Check with the doctor before taking any regular medications.
Inform the doctor of any allergies.
Empty the bladder and bowel.

Procedure

The patient has an IV line attached for administration of medications and fluids.
An anesthesiologist administers anesthesia and monitors the patient’s vital functions during the procedure.
The patient is intubated to provide oxygen.
The surgeon
Inserts a nasogastric tube to decompress the stomach.
Performs a gastric lavage (stomach pumping) to remove residual gastric content.
Makes one or more incisions in the abdomen depending on the type of surgery.
Introduces carbon dioxide into the abdomen in case of a laparoscopic surgery.
Finds, excises and removes the diseased part of the stomach.
May also remove other parts of the gastrointestinal tract if there is presence of cancer.
May remove other organs such as spleen or pancreas, if there are visible signs of cancer.
Removes adjacent lymph nodes to prevent metastasis.
Connects the remaining portion of the stomach to the duodenum or jejunum, with staples or sutures.
Rinses the abdominal cavity with saline (lavage).
Places a surgical drain and closes the incisions with sutures.

Post-procedure

The patient is brought out of anesthesia and administered painkillers for post-surgical pain.
The patient will be monitored in the recovery room for several hours until vital functions are stable.
People with malignancies and comorbid conditions are likely to require continued treatment.

How long does it take to recover from a partial gastrectomy?

A partial gastrectomy may require hospitalization of up to 2 weeks, or less, if the procedure is laparoscopic. The patient may require feeding through a tube inserted into the small intestine and fluids through an IV line during the recovery period in the hospital.

The patient may be able to eat normally after the surgical wound heals, but may have to be on a special diet and avoid spicy, fatty or sugary foods. Without complications, full recovery can be expected in 6 weeks, during which period the patient must avoid heavy lifting and strenuous activities.

Pancreatitis is inflammation of an organ in the abdomen called the pancreas. See Answer

References

Medscape Medical Reference

Gastrectomy surgery is a form of major abdominal surgery that will mean having both a short hospital stay and a longer recovery period at home. Most people will have restrictions on activity when first going home from the hospital.

The healthcare team will give instructions on pain management, diet, safe activity levels, and when it will be possible to return to work or school. The recovery from surgery will be gradual and it may take several weeks to safely get back to pre-surgery activity levels.

Most people will have a short hospital stay after having gastrectomy surgery. The length of the stay will depend on a number of factors, including why the gastrectomy was done, how much of the stomach was removed, and if there were any complications.

The average length of stay for laparoscopic surgery for a total gastrectomy is about 7 days. Upon being released from the hospital, the surgical team will go over a set of instructions on how to recover at home.

After gastrectomy surgery, patients can expect to have a follow-up appointment with their surgeon about a week later. This may be more or less depending on how well recovery is going and if there were any complications either in the hospital or later at home.

Patients might be able to make this appointment before leaving the hospital or may have to call the surgeon’s office upon arriving home. Driving so soon after surgery isn’t possible, therefore, a friend or family member will need to be available to drive to the appointment.

During the first office visit after the operation, the surgeon will want to look at the surgical site on the abdomen to see how it is healing. The surgeon will look for any signs of an infection.

If there were staples used to close the surgical wound, those are often removed during the first visit. Removing staples may be uncomfortable, so it’s important to make sure that there is a plan to manage pain before going to the appointment.

If the wound was closed with Steri-Strips or glue, they will fall off or loosen on their own or can be removed when the surgeon says it is safe to do so (usually around 10 days after surgery).

Follow-up with other physicians besides the surgeon may also be necessary. For those who have been diagnosed with stomach cancer, there may be a need to see an oncologist or other specialists.

Some patients may also wish to see a dietitian for help in determining an eating plan for the days and weeks after surgery and in learning if there is a need for vitamin supplements.

Restrictions on activities in the first few weeks after surgery will be different for every person. However, some general guidelines are:

Eating small, frequent meals as instructed at discharge
Not lifting anything over 5 pounds for about six weeks
Don’t drive for at least three weeks (in some cases, this may be extended)
No baths in a tub until the surgeon says it’s OK (showers are fine)
Avoid strenuous exercise until discussing it with the surgeon
Avoid sexual intercourse until the surgeon says it’s OK

A return to work or school will be variable based on a number of different factors. In many cases, however, it will be about four to six weeks before going back to regular activities will be possible.

Consider starting back at a part-time or a reduced schedule, which is recommended to avoid becoming too fatigued. For those who have jobs that include strenuous activity, there may be different guidelines as to how to work towards building stamina back up to where it was prior to surgery.

The most important thing to remember about a recovery timeline is to discuss everything with the surgical team and get answers about when resuming daily activities is possible.

If everything is not discussed either when leaving the hospital or at the first post-surgery appointment, making a call to the surgeon’s office or using the patient portal are good ways to get simple questions answered.

It might also be necessary to get a formal document from the surgeon in order to return to work. Check with an employer and the insurance company to find out if this is needed.

Going home after surgery, most people will need some help for practical things, like grocery shopping, making meals, doing laundry, cleaning, and even showering. Having a family member or friend available to help with these everyday tasks will go a long way towards making recovery from surgery more comfortable.

It may be possible to have a visiting nurse service make a house call to attend to the surgical wound and other medical needs. Check with the insurance carrier to see what services may be available.

Pain management is an important part of the recovery from surgery. Patients will receive instructions about pain medications when leaving the hospital. The first post-surgery appointment is a good time to go over the pain management plan again, especially if pain levels are still high. It may be necessary to change the plan or to get refills of any prescription pain medications that are still needed.

Recovering from surgery is a long and involved process. It is common to deal with many different emotions about the disruption to one’s life and the changes that are needed. Some people may feel angry, sad, depressed, irritable, or nervous. These feelings are to be expected.

Talk to a member of the healthcare team right away if it becomes difficult to manage daily activities because of a feeling of being depressed or overwhelmed. There is help available in dealing with the emotions surrounding this major change and the adjustment period, which can include a mental health professional, a social worker, or nursing staff.

For open surgery, there will be a surgical wound that goes from the breastbone down to below the belly button. For laparoscopic surgery, there will be several small wounds.

The wound(s) might be closed with staples, Steri-Strips, or glue. Bandages over the wound should be changed at least once a day, or as spelled out in the discharge papers from the hospital. If the bandages become too wet because of drainage, they should be changed more often.

When changing the bandages, it’s important to look at the surgical site and make sure it looks healthy and there isn’t an infection starting. Signs of an infection to watch for include:

An increase in pain
Excessive drainage (pus)
Feeling generally unwell
Fever
Redness
Swelling

Call the surgeon’s office if there are any concerns about the appearance of the wound.

The recovery from gastrectomy surgery will take several weeks and is a challenging time. Patients are not only coping with the physical aspects of having surgery such as pain and restrictions, but also the mental side of the diagnosis for which the surgery was done as well as a new way of life after healing.

It’s important to remember to give oneself time to adjust and to use the resources that are available from the healthcare team. Relying on family and friends during this time is also helpful and will make recovery easier to manage.