From the Guidelines
An antrectomy is a surgical procedure that involves the removal of the distal portion (antrum) of the stomach, and the steps of the procedure include mobilization of the stomach, ligation and division of the right gastric and gastroepiploic vessels, duodenum mobilization, stomach transection, and gastrointestinal continuity restoration. The procedure begins with general anesthesia administration and appropriate patient positioning 1. The surgeon makes an upper midline abdominal incision to access the peritoneal cavity. After exploring the abdomen, the surgeon mobilizes the stomach by dividing the greater and lesser omentum along the greater and lesser curvatures.
- The left gastric vessels are identified and preserved while the right gastric and gastroepiploic vessels are ligated and divided.
- The duodenum is mobilized using the Kocher maneuver, then transected approximately 1-2 cm distal to the pylorus.
- The stomach is then transected proximally at the junction between the antrum and the body, typically removing about 30-40% of the distal stomach. The extent of lymph node dissection accompanying radical gastrectomy has been extensively debated, with D2 resection implying removal of additional lymph nodes along the proper or common hepatic artery, splenic artery or coeliac axis 1. Gastrointestinal continuity is restored through a gastroduodenostomy (Billroth I) or gastrojejunostomy (Billroth II) reconstruction.
- The surgeon then checks for hemostasis, places drains if necessary, and closes the abdominal wall in layers. Antrectomy is commonly performed for peptic ulcer disease complications, gastric polyps, or early gastric cancer, and patients with curable cancers of the stomach should undergo a D2 lymphadenectomy 1. Postoperatively, patients require close monitoring for complications such as bleeding, anastomotic leak, or delayed gastric emptying. Laparoscopic surgery has the potential benefits of decreased post-operative morbidity and reduced recovery time, with a lymph node yield comparable with open surgery 1.
From the Research
Steps of an Antrectomy
The steps of an antrectomy are not explicitly outlined in the provided studies. However, based on the information available, the following can be inferred:
- Antrectomy is a surgical procedure that involves the removal of the antrum, which is the lower portion of the stomach 2, 3, 4, 5, 6.
- The procedure can be performed alone or in combination with other surgical techniques, such as vagotomy or Roux-en-Y gastrojejunostomy 2, 3, 4, 5.
- The goal of antrectomy is to reduce gastric acid secretion and alleviate symptoms associated with conditions such as peptic ulcer disease or gastroesophageal reflux disease 2, 3, 4, 5.
Key Considerations
Some key considerations related to antrectomy include:
- Patient selection: The decision to perform antrectomy alone or in combination with other procedures depends on various factors, including the patient's preoperative gastric acid secretory capacity and the location of the ulcer 2.
- Surgical technique: The procedure involves the removal of the antrum, and the surgical technique may vary depending on the specific condition being treated and the surgeon's preference 3, 4, 5, 6.
- Postoperative outcomes: Antrectomy can be an effective treatment for certain conditions, but it may also be associated with complications such as dumping and diarrhea, particularly when performed in combination with vagotomy 2, 5.
Specific Procedures
Some specific procedures that involve antrectomy include: