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Partial gastrectomy and gastrointestinal reconstruction

Debrah Wirtzfeld, MD, MSc, FRCSC, FACS
Section Editor
David I Soybel, MD
Deputy Editor
Wenliang Chen, MD, PhD


Partial gastric resection is used to treat cases of benign gastric disease for which resection is indicated, malignant gastric tumors, such as adenocarcinoma, where sufficient margins can be achieved, selected cases of gastrointestinal stromal tumor (GIST), and to manage complications related to conservative management lymphomas. The first antrectomy for gastric cancer was performed by Ludwik Rydygier in 1880 [1]. The patient lived for 12 hours, passing away from postoperative shock. The first antrectomy in which the patient survived the operation was performed by Theodor Billroth in 1881 [1]. The patient subsequently passed away from metastatic disease. Antral resection was felt by many to be too severe for the treatment of benign disease, but partial gastrectomy became the treatment of choice for ulcer disease after a seminal paper was published in 1910 [1,2]. However, surgery is uncommonly needed in the era of modern anti-ulcer therapies, being reserved predominantly for complications or refractory disease.

The extent of gastric resection and type of reconstruction chosen impacts the nature of perioperative and later complications, particularly the development of postgastrectomy syndromes. In Japan and other countries where the incidence of early gastric cancer is common, function-preserving techniques, including pylorus preserving segmental gastrectomy (PPSG) and vagus nerve preservation, have been promoted. The role of these techniques in treating patients in North America has not been well studied. A variety of options following partial gastrectomy are available to restore gastrointestinal continuity, the most common of which are the Billroth I, Billroth II, and Roux-en-Y reconstructions.

The indications and techniques for partial gastric resection and reconstruction, perioperative care, and complications will be reviewed here. The diagnosis and management of pathologies that may indicate the need for partial gastric resection are discussed in separate topic reviews. Total gastrectomy and reconstruction are discussed separately. (See "Total gastrectomy and gastrointestinal reconstruction".)


The stomach is located in the left upper quadrant of the abdomen. Anteriorly, the stomach is related to the left lateral lobe of the liver, diaphragm, colon, omentum, and anterior abdominal wall (figure 1). Posteriorly, the stomach is associated with the pancreas, spleen, left kidney and adrenal gland, splenic artery, and the left diaphragm (figure 2 and figure 3).

The stomach is divided anatomically into five sections, with each section based upon histologic differences and with each having a unique role in the process of digestion (figure 4). These sections include [3] (see "Physiology of gastric acid secretion")


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