Total gastrectomy video
December 17, 2008 § 12 Comments
The stomach exposed through the midline incision.
My last video in 2008, this total gastrectomy with Roux-en-Y reconstruction for stomach cancer, was published today on www.oncolex.no.
The video was recorded in February, and I wrote a post about the experience then. I’ve pasted the description of the operation below. Voice overs in Norwegian.
The patient had a large tumor in the upper part of the stomach, close to the cardia. The tumor had also grown very close to the spleen, so that would have to go too, together with the entire stomach.
The first part of the operation was pretty straight forward. The blood supply and nerves of the stomach was cut. Using an instrument called GIA, which places two double rows of staples and cuts between them in one move, the duodenum and stomach was divided below the pylorus. The esophagus was separated from the stomach the same way. The spleen was then dissected and the operation specimen was removed.
The surgical specimen with stomach (left) and spleen (right).
The second part took a little more thinking on my part before I understood the plumbing. No disrespect to the gastrointestinal surgeons, but this really was advanced plumbing. OK. Remember that both the esophagus and the upper part of the duodenum is closed. One could think that these ends were going to be joined together, but no. Most of the gastric juices enter the small intestine in the duodenum from the pancreatic duct and the common bile duct. If the duodenum was connected directly to the esophagus, bile could enter the esophagus and cause problems. So another solution has to be found.
First the surgeons separated the lower part of the duodenum from the jejunum with the GIA, sealing both ends. Then they made an anastomosis between the esophagus and the jejunum 40 cm below the ligament of Treitz. Finally they made an anastomosis between the bottom part of the duodenum and the jejunum 40 cm below the first anastomosis. The upper part of the duodenum was left closed. So the food would go directly from the esophagus to the jejunum, and join with the gastric juices from the duodenum after 40 cm. The surgeons explained it to me as they were working, but I didn’t really get it until I looked up an illustration in a book the next day (photo credit). Advanced plumbing indeed.
The Sterile Eye 
Well in my job as a plumber I’ve seen some disgusting things, but thank goodness I’ve never opened a pipe and found anything like the images shown here.
“Plumber found stomach in pipe”. Now that would truly be disturbing ;)
What kinds of things have you seen Mr. Plumber?
hello, i need a favor, can you help me with the translation to english about the explanation of the procedure in the video? I’d really appreciate to. Thanks
Andrea: Check your email for reply.
Thank you for the video. I had a total gastrectomy due to stomach cancer in January 2010. I have read plenty on it and have seen the sketches but actually seeing the real surgery gave me a deeper appreciation for the work involved. My docs didn’t remove the spleen but they did nick it during surgery resulting in blood loss and transfusion.
To bad the same docs don’t know how to “fix the plumbing” when complications arise after surgery http://lifeaftergastrectomy.wordpress.com
Question: I can’t understand the language but it appears that they didn’t remove any lymph nodes to check if the cancer had spread – why not?
I’m glad you found the video useful, even though it’s only available in Norwegian.
They probably did remove lymph nodes during this operation, as it is standard procedure. The video however, is a part of a larger library of procedures, and the lymph node dissection (LND) was therefore edited out to make a shorter video, as LND is covered elsewhere.
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have you tried making a pouch by doing a side to side loop anastomosis, closing off the open end and anastomosing the oesophagus end to side at the top. this leaves a ‘stomach pouch’. I found it works well. Hard to describe, easier to draw.
I only film operations, Michael. I’m a photographer, not a surgeon :)
Hello, i had a total gastrectomy 2 months ago and would love to watch this video but when i try it says that the link is invalid? Or the video has been moved?
Hi Kara,
I have updated the link, and it’s now working. Thanks for notifying me!