The
GALE
E
NCYCLOPEDIA
o
f
Surgery
A GUIDE FOR PATIENTS AND CAREGIVERS
VOLUME
G-O
ANTHONY J. SENAGORE, M.D., EXECUTIVE ADVISOR
CLEVELAND CLINIC FOUNDATION
The
GALE
E
NCYCLOPEDIA
o
f
Surgery
A GUIDE FOR PATIENTS AND CAREGIVERS
2
Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers
Anthony J. Senagore MD, Executive Adviser
Project Editor
Kristine Krapp
Editorial
Stacey L. Blachford, Deirdre Blanchfield,
Madeline Harris, Chris Jeryan, Jacqueline
Longe, Brigham Narins, Mark Springer,
Ryan Thomason
Editorial Support Services

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LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

Adenoidectomy
Admission to the hospital
Adrenalectomy
Adrenergic drugs
Adult day care
Ambulatory surgery centers
Amniocentesis
Amputation
Anaerobic bacteria culture
Analgesics
Analgesics, opioid
Anesthesia evaluation
Anesthesia, general
Anesthesia, local
Anesthesiologist’s role
Angiography
Angioplasty
Anterior temporal lobectomy
Antianxiety drugs
Antibiotics
Antibiotics, topical
Anticoagulant and antiplatelet drugs
Antihypertensive drugs
Antinausea drugs
Antiseptics
Antrectomy
Aortic aneurysm repair
Aortic valve replacement
Breast reduction
Bronchoscopy

Colpotomy
Appendectomy
Arteriovenous fistula
Arthrography
Arthroplasty
Arthroscopic surgery
Artificial sphincter insertion
Aseptic technique
Aspirin
Autologous blood donation
Axillary dissection
B
Balloon valvuloplasty
Bandages and dressings
Bankart procedure
Barbiturates
Barium enema
Bedsores
Biliary stenting
Bispectral index
Bladder augmentation
Blepharoplasty
Blood donation and registry
Blood pressure measurement
Blood salvage
Bloodless surgery
Bone grafting
Bone marrow aspiration and biopsy
Bone marrow transplantation
Bone x rays

Defibrillation
Dental implants
Dermabrasion
Dilatation and curettage
Discharge from the hospital
Disk removal
Diuretics
Do not resuscitate order (DNR)
E
Ear, nose, and throat surgery
Echocardiography
Elective surgery
Electrocardiography
Electroencephalography
Electrolyte tests
Electrophysiology study of the heart
Emergency surgery
Endolymphatic shunt
Gastrostomy
General surgery
Gingivectomy
Glossectomy
Glucose tests
Goniotomy
H
Hair transplantation
Hammer, claw, and mallet toe
surgery
Hand surgery
Health care proxy

cholangiopancreatography
Endoscopic sinus surgery
Endotracheal intubation
Endovascular stent surgery
Enhanced external counterpulsation
Enucleation, eye
Epidural therapy
Episiotomy
Erythromycins
Esophageal atresia repair
Esophageal function tests
Esophageal resection
Esophagogastroduodenoscopy
Essential surgery
Exenteration
Exercise
Extracapsular cataract extraction
Eye muscle surgery
F
Face lift
Fasciotomy
Femoral hernia repair
Fetal surgery
Fetoscopy
Fibrin sealants
Finding a surgeon
Finger reattachment
Fluoroquinolones
Forehead lift
Fracture repair

Islet cell transplantation
K
Kidney dialysis
Kidney function tests
Kidney transplantation
Knee arthroscopic surgery
Knee osteotomy
Knee replacement
Knee revision surgery
Kneecap removal
L
Laceration repair
Laminectomy
Laparoscopy
Laparoscopy for endometriosis
Laparotomy, exploratory
Laryngectomy
Laser in-situ keratomileusis (LASIK)
Laser iridotomy
Laser posterior capsulotomy
Laser skin resurfacing
Laser surgery
Laxatives
Leg lengthening/shortening
N
Necessary surgery
Needle bladder neck suspension
Nephrectomy
Nephrolithotomy, percutaneous
Nephrostomy

Pectus excavatum repair
Pediatric concerns
Pediatric surgery
Limb salvage
Lipid tests
Liposuction
Lithotripsy
Liver biopsy
Liver function tests
Liver transplantation
Living will
Lobectomy, pulmonary
Long-term care insurance
Lumpectomy
Lung biopsy
Lung transplantation
Lymphadenectomy
M
Magnetic resonance imaging
Mammography
Managed care plans
Mastoidectomy
Maze procedure for atrial
fibrillation
Mechanical circulation support
Mechanical ventilation
Meckel’s diverticulectomy
Mediastinoscopy
Medicaid
Medical charts

Photocoagulation therapy
Photorefractive keratectomy (PRK)
Physical examination
Planning a hospital stay
Plastic, reconstructive, and
cosmetic surgery
Pneumonectomy
Portal vein bypass
Positron emission tomography (PET)
Post-surgical pain
Postoperative care
Power of attorney
Preoperative care
Preparing for surgery
Presurgical testing
Private insurance plans
Prophylaxis, antibiotic
Pulse oximeter
Pyloroplasty
Q
Quadrantectomy
R
Radical neck dissection
Recovery at home
Recovery room
Rectal prolapse repair
Rectal resection
Red blood cell indices
Reoperation
Retinal cryopexy

Tube enterostomy
Tube-shunt surgery
Tumor marker tests
Tumor removal
Tympanoplasty
Type and screen
U
Umbilical hernia repair
Upper GI exam
Ureteral stenting
Ureterosigmoidoscopy
Ureterostomy, cutaneous
Rhinoplasty
Rhizotomy
Robot-assisted surgery
Root canal treatment
Rotator cuff repair
S
Sacral nerve stimulation
Salpingo-oophorectomy
Salpingostomy
Scar revision surgery
Scleral buckling
Sclerostomy
Sclerotherapy for esophageal
varices
Sclerotherapy for varicose veins
Scopolamine patch
Second opinion
Second-look surgery

Urinary anti-infectives
Urologic surgery
Uterine stimulants
V
Vagal nerve stimulation
W
Webbed finger or toe repair
Weight management
White blood cell count and
differential
Wound care
Wound culture
Wrist replacement
Vagotomy
Vascular surgery
Vasectomy
Vasovasostomy
Vein ligation and stripping
Venous thrombosis prevention
Ventricular assist device
Ventricular shunt
Vertical banded gastroplasty
Vital signs
GALE ENCYCLOPEDIA OF SURGERY
xi
List of Entries
The Gale Encyclopedia of Surgery is a medical ref-
erence product designed to inform and educate readers
about a wide variety of surgeries, tests, drugs, and other
medical topics. The Gale Group believes the product to

performs the surgery and where, and on questions to
ask the doctor.
This encyclopedia minimizes medical jargon and
uses language that laypersons can understand, while still
providing detailed coverage that will benefit health sci-
ence students.
Entries on surgeries follow a standardized format
that provides information at a glance. Rubrics include:
Definition
Purpose
Demographics
Description
Diagnosis/Preparation
Aftercare
Risks
Normal results
Morbidity and mortality rates
Alternatives
Resources
Inclusion criteria
A preliminary list of surgeries and related topics
was compiled from a wide variety of sources, including
professional medical guides and textbooks, as well as
consumer guides and encyclopedias. Final selection of
topics to include was made by the executive adviser in
conjunction with the Gale editor.
About the Executive Adviser
The Executive Adviser for the Gale Encyclopedia of
Surgery was Anthony J. Senagore, MD, MS, FACS,
FASCRS. He has published a number of professional ar-

INTRODUCTION
• The Resources section directs readers to additional
sources of medical information on a topic. Books, peri-
odicals, organizations, and internet sources are listed.
• A Glossary of terms used throughout the text is col-
lected in one easy-to-use section at the back of book.
• A valuable Organizations appendix compiles useful
contact information for various medical and surgical
organizations.
• A comprehensive General index guides readers to all
topics mentioned in the text.
Graphics
The Gale Encyclopedia of Surgery contains over 230
full-color illustrations, photos, and tables. This includes
over 160 step-by-step illustrations of surgeries. These il-
lustrations were specially created for this product to en-
hance a layperson’s understanding of surgical procedures.
Licensing
The Gale Encyclopedia of Surgery is available for li-
censing. The complete database is provided in a fielded
format and is deliverable on such media as disk or CD-
ROM. For more information, contact Gale’s Business
Development Group at 1-800-877-GALE, or visit our
website at www.gale.com/bizdev.
GALE ENCYCLOPEDIA OF SURGERY
xiv
Introduction
Laurie Barclay, M.D.
Neurological Consulting Services
Tampa, FL

Lorraine K. Ehresman
Medical Writer
Northfield, Quebec, Canada
L. Fleming Fallon, Jr., MD,
DrPH
Professor of Public Health
Bowling Green State University
Bowling Green, OH
Paula Ford-Martin
Freelance Medical Writer
Warwick, RI
Janie Franz
Freelance Journalist
Grand Forks, ND
Rebecca J. Frey, PhD
Freelance Medical Writer
New Haven, CT
Debra Gordon
Medical Writer
Nazareth, PA
Jill Granger, M.S.
Sr. Research Associate
Dept. of Pathology
University of Michigan Medical
Center
Ann Arbor, MI
Laith F. Gulli, M.D.
M.Sc., M.Sc.(MedSci), M.S.A.,
Msc.Psych, MRSNZ
FRSH, FRIPHH, FAIC, FZS

Victoria E. DeMoranville
Medical Writer
Lakeville, MA
Altha Roberts Edgren
Medical Writer
Medical Ink
St. Paul, MN
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xv
CONTRIBUTORS
Stephen John Hage, AAAS,
RT(R), FAHRA
Medical Writer
Chatsworth, CA
Maureen Haggerty
Medical Writer
Ambler, PA
Robert Harr, MS, MT (ASCP)
Associate Professor and Chair
Department of Public and Allied
Health
Bowling Green State University
Bowling Green, OH
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Medical Writer
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Medical Writer
Deep River, CT
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BS, RT, RDMS
Medical Writer
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Freelance Medical Writer
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Medical Writer
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Medical Writer
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Medical Student
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GALE ENCYCLOPEDIA OF SURGERY
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Contributors
Richard Robinson
Freelance Medical Writer
Sherborn, MA
Nancy Ross-Flanigan
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Medical Writer
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Kathleen D. Wright, R.N.
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Mary Zoll, Ph.D.
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Medical Writer
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Lee A. Shratter, MD
Consulting Radiologist
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Medical Writer
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Circulation Technologist
The Ohio State University
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Medical Writer
Los Gatos, CA

chemicals are out of balance, one or the other will not re-
main in solution. Dietary fat and cholesterol are also im-
plicated in crystal formation.
As the bile crystals aggregate to form stones, they
move about, eventually occluding the outlet and prevent-
ing the gallbladder from emptying. This blockage results
in irritation, inflammation, and sometimes infection
(cholecystitis) of the gallbladder. The pattern is usually
one of intermittent obstruction due to stones moving in
and out of the way. Meanwhile, the gallbladder becomes
more and more scarred. Sometimes infection fills the gall-
bladder with pus, which is a serious complication.
Occasionally, a gallstone will travel down the cystic
duct into the common bile duct and get stuck there. This
blockage will back bile up into the liver as well as the
gallbladder. If the stone sticks at the ampulla of Vater (a
narrowing in the duct leading to the pancreas), the pan-
creas will also be blocked and will develop pancreatitis.
Gallstones will cause a sudden onset of pain in the
upper abdomen. Pain will last for 30 minutes to several
hours. Pain may move to the right shoulder blade. Nau-
sea with or without vomiting may accompany the pain.
Demographics
Gallstones are approximately two times more com-
mon in females than in males. Overweight women in
their middle years constitute the vast majority of patients
with gallstones in every racial or ethnic group. An esti-
mated 10% of the general population has gallstones. The
prevalence for women between ages 20 and 55 varies
from 5–20%, and is higher after age 50 (25–30%). The

had previously been the standard procedure; however, not
everyone is a candidate for this approach. If the procedure
is not expected to have complications, laparoscopic chole-
cystectomy is performed. Laparoscopic surgery requires a
space in the surgical area for visualization and instrument
manipulation. The laparoscope with attached video cam-
era is inserted. Several other instruments are inserted
through the abdomen (into the surgical field) to assist the
surgeon to maneuver around the nearby organs during
surgery. The surgeon must take precautions not to acci-
dentally harm anatomical structures in the liver. Once the
cystic artery has been divided and the gallbladder dissect-
ed from the liver, the gallbladder can be removed.
If the gallbladder is extremely diseased (inflamed,
infected, or has large gallstones), the abdominal ap-
proach (open cholecystectomy) is recommended. This
surgery is usually performed with an incision in the
upper midline of the abdomen or on the right side of the
abdomen below the rib (right subcostal incision).
If a stone is lodged in the bile ducts, additional
surgery must be done to remove it. After surgery, the sur-
geon will ordinarily insert a drain to collect bile until the
system is healed. The drain can also be used to inject
contrast material and take x rays during or after surgery.
A procedure called endoscopic retrograde cholan-
giopancreatoscopy (ERCP) allows the removal of some
bile duct stones through the mouth, throat, esophagus,
stomach, duodenum, and biliary system without the need
for surgical incisions. ERCP can also be used to inject
contrast agents into the biliary system, providing finely

at risk for poor clearance rates. Complications of shock
wave lithotripsy include inflammation of the pancreas
(pancreatitis) and acute cholecystitis.
A method called contact dissolution of gallstone re-
moval involves direct entry (via a percutaneous transhe-
patic catheter) of a chemical solvent (such as methyl ter-
tiary-butyl ether, MTBE). MTBE is rapidly removed un-
changed from the body via the respiratory system (ex-
haled air). Side effects in persons receiving contact
dissolution therapy include foul-smelling breath, dysp-
nea (difficulty breathing), vomiting, and drowsiness.
Treatment with MTBE can be successful in treating cho-
lesterol gallstones regardless of the number and size of
stones. Studies indicate that the success rate for dissolu-
tion is well over 95% in persons who receive direct
chemical infusions that can last five to 12 hours.
Diagnosis/Preparation
Diagnostically, gallstone disease, which can lead to
gallbladder removal, is divided into four diseases: biliary
colic, acute cholecystitis, choledocholithiasis, and
cholangitis. Biliary colic is usually caused by intermit-
tent cystic duct obstruction by a stone (without any in-
flammation), causing a severe, poorly localized, and in-
tensifying pain on the upper right side of the abdomen.
GALE ENCYCLOPEDIA OF SURGERY
558
Gallstone removal
WHO PERFORMS
THE PROCEDURE AND
WHERE IS IT PERFORMED?

bloodstream (bacteremia). The majority of patients with
cholangitis will have fever (95%), tenderness in the
upper right side of the abdomen, and jaundice (80%).
In addition to a physical examination, preparation
for laboratory (blood) and special tests is essential to
gallstone diagnosis. Patients with biliary colic may have
elevated bilirubin and should have an ultrasound study to
visualize the gallbladder and associated structures. An
increase in the white blood cell count (leukocytosis) can
be expected for both acute cholecystitis and cholangitis
(seen in 80% of cases). Ultrasound testing is recom-
mended for acute cholecystitis patients, whereas ERCP
is the test usually indicated to assist in a definitive diag-
nosis for both choledocholithiasis and cholangitis. Pa-
tients with either biliary colic or choledocholithiasis are
treated with elective laparoscopic cholecystectomy.
Open cholecystectomy is recommended for acute chole-
cystitis. For cholangitis, emergency ERCP is indicated
for stone removal. ERCP therapy can remove stones pro-
duced by gallbladder disease.
Aftercare
Without a gallbladder, stones rarely recur. Patients
who have continued symptoms after their gallbladder is
removed may need an ERCP to detect residual stones or
damage to the bile ducts caused by the original stones.
Occasionally, the ampulla of Vater is too tight for bile to
flow through and causes symptoms until it is opened up.
Risks
The most common medical treatment for gallstones
is the surgical removal of the gallbladder (cholecsytecto-

GALE ENCYCLOPEDIA OF SURGERY
559
Gallstone removal
QUESTIONS TO ASK
THE DOCTOR
• How long must I remain in the hospital fol-
lowing gallstone removal?
• How do I care for the my incision site?
• How soon can I return to normal activities
following gallstone removal?
Resources
BOOKS
Bennett, J. Claude, and Fred Plum, eds. Cecil Textbook of Med-
icine. Philadelphia: W. B. Saunders Co., 1996.
Bilhartz, Lyman E., and Jay D. Horton. “Gallstone Disease and
Its Complications.” In Sleisenger & Fordtran’s Gastroin-
testinal and Liver Disease, edited by Mark Feldman, et al.
Philadelphia: W. B. Saunders Co., 1998.
Fauci, Anthony S., et al., editors. Harrison’s Principles of In-
ternal Medicine. New York: McGraw-Hill, 1997.
Feldman, Mark, editor. Sleisenger & Fordtran’s Gastrointesti-
nal and Liver Disease, 7th Edition. St. Louis: Elsevier
Science, 2002.
Hoffmann, Alan F. “Bile Secretion and the Enterohepatic Cir-
culation of Bile Acids.” In Sleisenger & Fordtran’s Gas-
trointestinal and Liver Disease, edited by Mark Feldman,
et al. Philadelphia: W. B. Saunders Co., 1998.
Mulvihill, Sean J. “Surgical Management of Gallstone Disease
and Postoperative Complications.” In Sleisenger & Ford-
tran’s Gastrointestinal and Liver Disease, edited by Mark

the wrist, with another 20%–25% on the volar (palm) sur-
face of the hand. Most of the remaining 10%–15% of gan-
glion cysts occur on the sheath of the flexor tendon. In a
few cases, the cysts emerge on the sole of the foot.
Ganglion cysts have appeared in medical writing
from the time of Hippocrates (c. 460–c. 375 B. C.). Their
exact cause is unknown. There are some indications,
however, that ganglion cysts result from trauma to or de-
terioration of the tissue lining in the joints that secretes
synovial fluid.
GALE ENCYCLOPEDIA OF SURGERY
560
Ganglion cyst removal
KEY TERMS
Bilirubin—A pigment released from red blood cells.
Cholecystectomy—Surgical removal of the gall-
bladder.
Cholelithotomy—Surgical incision into the gall-
bladder to remove stones.
Contrast agent—A substance that causes shadows
on x rays (or other images of the body).
Cystic artery—An artery that brings oxygenated
blood to the gallbladder.
Endoscope—An instrument designed to enter
body cavities.
Jaundice—A yellow discoloration of the skin and
eyes due to excess bile that is not removed by the
liver.
Laparoscopy—Surgery performed through small
incisions with pencil-sized instruments.

glion cysts unless they cause pain, affect the move-
Ganglion cysts can emerge quite quickly, and can
disappear just as fast. They are benign growths, usual-
ly causing problems in the functioning of the joints or
ment of the nearby tendons, or become particularly un-
sightly.
An old traditional treatment for a ganglion cyst was
to hit it with a Bible, since the cysts can burst when
struck. Today, cysts are removed surgically by aspiration
but often reappear. Surgical excision is the most reliable
treatment for ganglion cysts, but aspiration is the more
common form of therapy.
Demographics
Ganglion cysts account for 50%–70% of all soft tis-
sue tumors of the hand and wrist. They are most likely to
occur in adults between the ages of 20 and 50, with the
female: male ratio being about 3: 1. Most ganglion cysts
are visible; however, some are occult (hidden). Occult
cysts may be diagnosed because the patient feels pain in
that part of the hand or has noticed that the tendon can-
not move normally. In about 10% of cases, there is asso-
ciated trauma.
Description
Patients are given a local or regional anesthetic in a
doctor’s office. Two methods are used to remove the
cysts. Most physicians use the more conservative proce-
dure, which is known as aspiration.
Aspiration
• An 18- or 22-gauge needle attached to a 20–30-mL sy-
ringe is inserted into the cyst. The doctor removes the

Aftercare
Patients should avoid strenuous physical activity for
at least 48 hours after surgery and report any signs of in-
fection or inflammation to their physician. A follow-up
appointment should be scheduled within three weeks of
aspiration or excision. Excision may result in some stiff-
ness after the surgery and some difficulties in flexing the
hand because of scar tissue formation.
Risks
Aspiration has very few complications as a treat-
ment for ganglion cysts; the most common aftereffects
are infection or a reaction to the cortisone injection.
Complications of excision include some stiffness in the
hand and scar formation. Ganglion cysts recur after exci-
sion in about 5–15% of cases, usually because the cyst
was not completely removed.
Normal results
Aspirated ganglion cysts disappear and cause no
further symptoms in 27–67% of cases. They may, how-
GALE ENCYCLOPEDIA OF SURGERY
562
Ganglion cyst removal
QUESTIONS TO ASK
THE DOCTOR
• May I continue to exercise and continue my
other regular activities with this cyst?
• Would you recommend removal rather than
aspiration?
• How effective is aspiration in preventing
these cysts from recurring?

and eastern Asia, but other areas of the world have high
incidence rates, including Eastern European countries
and parts of Latin America. Incidence rates are generally
lower in Western Europe and the United States.
Gastrointestinal diseases (including gastric ulcers)
affect an estimated 25–30% of the world’s population. In
the United States, 60 million adults experience gastroin-
testinal reflux at least once a month, and 25 million
adults suffer daily from heartburn, a condition that may
evolve into ulcers.
Description
Gastrectomy for cancer
Removal of the tumor, often with removal of the
surrounding lymph nodes, is the only curative treatment
ever, reoccur and require repeated aspiration. Aspiration
combined with an injection of cortisone has more suc-
cess than aspiration by itself. Excision is a much more
reliable procedure, however, and the stiffness that the pa-
tient may experience after the procedure eventually goes
away. The formation of a small scar is normal.
Morbidity and mortality rates
The only risks for ganglion cyst removal are infec-
tions or inflammation due to the cortisone injection.
There is a small risk of damage to nearby nerves or
blood vessels.
Alternatives
Alternatives to aspiration and excision in the treat-
ment of ganglion cysts include watchful waiting and rest-
ing the affected hand or foot. It is quite common for gan-
glion cysts to fade away without any surgical treatment.

sole of the foot.
for various forms of gastric (stomach) cancer. For many
patients, this entails removing not only the tumor, but
part of the stomach as well. The extent to which lymph
nodes should also be removed is a subject of debate, but
some studies show additional survival benefits associat-
ed with removal of a greater number of lymph nodes.
Gastrectomy, either total or subtotal (also called par-
tial), is the treatment of choice for gastric adenocarcino-
mas, primary gastric lymphomas (originating in the
stomach), and the rare leiomyosarcomas (also called gas-
tric sarcomas). Adenocarcinomas are by far the most
common form of stomach cancer and are less curable
than the relatively uncommon lymphomas, for which
gastrectomy offers good chances of survival.
General anesthesia is used to ensure that the patient
does not experience pain and is not conscious during the
operation. When the anesthesia has taken hold, a urinary
catheter is usually inserted to monitor urine output. A thin
nasogastric tube is inserted from the nose down into the
stomach. The abdomen is cleansed with an antiseptic solu-
tion. The surgeon makes a large incision from just below
the breastbone down to the navel. If the lower end of the
stomach is diseased, the surgeon places clamps on either
end of the area, and that portion is excised. The upper part
of the stomach is then attached to the small intestine. If the
upper end of the stomach is diseased, the end of the
esophagus and the upper part of the stomach are clamped
together. The diseased part is removed, and the lower part
of the stomach is attached to the esophagus.

factorily to medical therapy; those who develop a bleed-
ing or perforated ulcer; and those who develop pyloric
obstruction, a blockage to the exit from the stomach.
The surgical procedure for severe ulcer disease is
also called an antrectomy, a limited form of gastrecto-
my in which the antrum, a portion of the stomach, is re-
moved. For duodenal ulcers, antrectomy may be com-
bined with other surgical procedures that are aimed at re-
ducing the secretion of gastric acid, which is associated
with ulcer formation. This additional surgery is com-
monly a vagotomy, surgery on the vagus nerve that dis-
ables the acid-producing portion of the stomach.
Diagnosis/Preparation
Before undergoing gastrectomy, patients require a
variety of such tests as x rays, computed tomography
(CT) scans, ultrasonography, or endoscopic biopsies (mi-
croscopic examination of tissue) to confirm the diagnosis
and localize the tumor or ulcer. Laparoscopy may be
done to diagnose a malignancy or to determine the extent
of a tumor that is already diagnosed. When a tumor is
strongly suspected, laparoscopy is often performed im-
mediately before the surgery to remove the tumor; this
method avoids the need to anesthetize the patient twice
and sometimes avoids the need for surgery altogether if
the tumor found on laparoscopy is deemed inoperable.
Aftercare
After gastrectomy surgery, patients are taken to the
recovery unit and vital signs are closely monitored by
GALE ENCYCLOPEDIA OF SURGERY
564

suture
Pylorus
Esophagus
Duodenum
Clamp
Stomach
Upper portion
of stomach
Jejunum
To remove a portion of the stomach in a gastrectomy, the surgeon gains access to the stomach via an incision in the ab-
domen.The ligaments connecting the stomach to the spleen and colon are severed (B).The duodenum is clamped and sepa-
rated from the bottom of the stomach, or pylorus (C).The end of the duodenum will be stitched closed.The stomach itself is
clamped, and the portion to be removed is severed (D).The remaining stomach is attached to the jejunum, another portion of
the small intestine (E). (Illustration by GGS Inc.)
the nursing staff until the anesthesia wears off. Patients
commonly feel pain from the incision, and pain medica-
tion is prescribed to provide relief, usually delivered in-
travenously. Upon waking from anesthesia, patients have
an intravenous line, a urinary catheter, and a nasogastric
tube in place. They cannot eat or drink immediately fol-
lowing surgery. In some cases, oxygen is delivered
through a mask that fits over the mouth and nose. The
nasogastric tube is attached to intermittent suction to
keep the stomach empty. If the whole stomach has been
removed, the tube goes directly to the small intestine and
remains in place until bowel function returns, which can
take two to three days and is monitored by listening with
a stethoscope for bowel sounds. A bowel movement is
also a sign of healing. When bowel sounds return, the
patient can drink clear liquids. If the liquids are tolerat-

ing, for example, eating smaller, more frequent meals
and limiting liquids.
Patients who have abdominal bloating and pain after
eating, frequently followed by nausea and vomiting, may
have what is called the “afferent loop syndrome.” This is
treated by surgical correction. Patients who have early
satiety (feeling of fullness after eating), abdominal dis-
comfort, and vomiting may have bile reflux gastritis
(also called bilious vomiting), which is also surgically
correctable. Many patients also experience weight loss.
Reactive hypoglycemia is a condition that results
when blood sugar levels become too high after a meal,
stimulating the release of insulin, occurring about two
hours after eating. A high-protein diet and smaller meals
are advised.
Ulcers recur in a small percentage of patients after
surgery for peptic ulcer, usually in the first few years.
Further surgery is usually necessary.
Vitamin and mineral supplementation is necessary
after gastrectomy to correct certain deficiencies, especial-
ly vitamin B
12
, iron, and folate. Vitamin D and calcium
are also needed to prevent and treat the bone problems
that often occur. These include softening and bending of
the bones, which can produce pain and osteoporosis, a
loss of bone mass. According to one study, the risk for
spinal fractures may be as high as 50% after gastrectomy.
Normal results
Overall survival after gastrectomy for gastric cancer