Antrectomy (Distal Gastrectomy) Periprocedural Care

Updated: May 31, 2019
  • Author: Christa N Grant, MD; Chief Editor: Kurt E Roberts, MD  more...
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Periprocedural Care

Patient Education and Consent

Patients should be counseled preoperatively about the common postoperative complications of antrectomy (distal gastrectomy) and how they may recognized, avoided, and alleviated. Often, lifestyle modification alone can prevent reoperation. Emphasizing the importance of postoperative follow-up tests and imaging specific to the patient's condition is also important.

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Preprocedural Planning

Upper gastrointestinal (GI) endoscopy is performed for patients with ulcer disease in order to determine the extent of disease and to obtain biopsies for ruling out carcinoma. Identification of ulcer location can determine the level of resection. In patients with carcinoma of the stomach, endoscopic ultrasonography (EUS) is often used in conjunction with computed tomography (CT) to determine the tumor's extent and resectability, and it has the added advantage of providing biopsy specimens.

In cases of ulcer disease caused by H pylori, repeat testing should be done to document the refractory nature of the disease.

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Equipment

GI anastomosis (GIA) and end-to-end anastomosis (EEA) staplers are used in creating the anastomoses.

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Patient Preparation

General endotracheal anesthesia is administered.

The patient is placed in a supine position. Reverse Trendelenburg positioning may improve exposure.

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Monitoring & Follow-up

Upper GI endoscopy, or esophagogastroduodenoscopy (EGD), is used routinely to screen for recurrent ulcer disease; it is also used diagnostically and potentially therapeutically in the event of a complication. In addition to surveillance for signs of recurrent ulcer disease, EGD has the added advantage of being therapeutic in the event of a postoperative complication such as stricture or bleeding. Patients undergoing resection for carcinoma undergo annual screening postoperatively.

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