In August 1996 I underwent a gastrectomy; the (more or less) complete removal of my stomach, to eradicate a growth that was 'on the turn' to becoming malignant. I was fortunate enough to be diagnosed early, so that I did not require chemotherapy or radiotherapy. The procedure was an effective 'cure' in itself.

While your surgeon or GP will give you information about the procedure and how to care for yourself afterwards, they are not equipped to tell you how it actually feels to undergo the procedure. Unless they have gone through the operation themselves, how can they know how it feels? Nobody can tell you quite like the gastrectomy patient what it really feels like to live daily with its effects.

Why a Gastrectomy?

Most gastric problems are relatively minor these days, and with modern medicines can soon be put right. However, for some forms of stomach cancer, or to cure a bleeding stomach ulcer, a partial or complete gastrectomy is the only effective treatment.

My problems stem from more than fifty years ago, when I developed an ulcer at age eleven. The medical and surgical techniques in the 1950s and 60s were nothing like as sophisticated as they are today. By age twenty-three I had undergone three deep abdominal operations, all related to the previous ulceration and a resultant adhesions problem. So the gastrectomy, performed years later, was the fourth and most drastic surgery.

The Operation

A gastrectomy is usually performed using the 'open' surgery technique, involving a large incision in the abdomen. This technique is almost always used in cases of stomach cancer. Sometimes a laparascopic technique ('keyhole surgery') can be used, where only a small incision is made and a surgical instrument called a laparoscope is inserted. A tiny video camera attached to the laparoscope feeds back images of the inside of the stomach which the surgeon views on a monitor.

Following the removal of the affected parts of the stomach, the remaining parts are attached to the small intestine, if possible, so that the patient can continue to digest food in as 'normal' a way as possible.

After the Operation

For the first week or two after the operation the patient is supplied with fluids via a drip through a tube in one of the veins of the arm. Sometimes (if, for example, the veins are collapsed) the tube is inserted into the upper-right chest and down inside the vena cava, a major blood vessel (vein) leading into a heart chamber. They call it a 'central line' (nothing to do with the London Underground). A feeding tube carrying liquid food may also be inserted into the small intestine until the patient is healed enough to take solid food by mouth.

The liquid food is ‘tailor made’ to the patient's particular nourishment needs. Daily blood tests determine what their body is short of, and by what measure it is deficient in a certain mineral or body chemical. Each new bag is adjusted to the updated needs shown as required by the body, by the laboratory that mixes the brew precisely in accord with the latest blood analysis.

It took me a full two weeks to reach the goal of coming off the drip feed and being able to eat solid food again. In the early days I had to learn to chew my food thoroughly before swallowing; when I forgot to do this I suffered quite severe pain for a few minutes, occasionally for an hour or two, depending on the nature and consistency of the food itself.

Once I was eating again I had to have regular vitamin B12 injections. At first, they gave me one every month, but found that my blood stock of the vitamin was far too high. It has been balanced correctly ever since on one every two months.

For some months after the operation the patient's blood is monitored to determine the presence, or the absence of cancer cells, and also do two or three endoscope inspections over several months to verify the results, over about six to thirty-six months.

Resuming 'Normal' Life

The hospital doctor told me that learning to live with the results and getting used to the 'new anatomy' would take some time, and this proved to be correct...

First Steps

After leaving the hospital, and taking a little walking exercise, the intestines seem to be flopping about inside one's belly, jelly-like. It is a weird sensation, due to the natural abdominal tissue that normally holds them in place being broken during the operation. This is not painful, but an irritating tickling sensation that makes one want to walk very slowly to avoid. This goes after about three to four weeks as the internal tissue heals. It is yet another example of the doctor's advice about getting used to the anatomy.

Eating Again

As can be imagined, after a gastrectomy the patient's capacity for food storage, which is one of the purposes of the stomach, is severely reduced. This is because the bottom of the oesophagus, the tube that usually leads to the stomach, is now connected to the upper intestine, which is surgically stretched to provide a cavity for the food before its digestion in the remaining long tube intestine.

A minority of patients have problems starting to eat again. Some will not eat, fearing great pain if they do so.The doctors have to persuade them to eat. Most are alright once they have swallowed their first couple of spoons of soup or other liquid; they then have the courage to try their first solids. A very small number of patients never eat solids again and have to have all their meals put through a liquidiser. This obviously has a very restrictive effect on social and work situations.

What to Eat and What to Avoid

The diet of a post-gastrectomy patient should be mainly of a highly nutritious and low bulk nature. It is essential to eat well in order to help the healing process. Alcohol can destroy the vitamins and minerals your body needs for that process. The diet should also be balanced well between protein and carbohydrate, with an element of fibre to help peristalsis, the muscular contractions which push food along the intestines. Meals need to be little and often, say every two hours or so. This presents a problem for patients who are working; and meeting your dietary needs in some professions can be well nigh impossible.

One learns how to balance one's intake of fruit and vegetable fibre over the months after the operation. I have been eating, on a daily basis, a large sweet and very juicy pear. Also about eight prunes a day and two or three pieces of dried peaches, all delicious. They provide all the fruit needs of the day. It is good to supplement them with a natural fruit drink and also to liquidise fruits and vegetables to make a 'smoothie'.

It is advisable to have a drink at your elbow such as water or real fruit juice (not alcohol or fizzy drinks, which can cause intestinal wind and restrict your already small capacity). This helps with the mastication of your food and softens it. Tea and coffee should also be avoided, as the caffeine destroys much of the vitamin and mineral content of your food.

I always drink plenty of filtered and boiled water to prevent dehydration and the dumping syndrome. The filtering and boiling takes the chlorine, limescale, heavy metals and other organic impurities out of the local tap water. It also guards against the intake of bacteria that may cause food poisoning.

Another important factor is the absorption of essential iron for blood production and health. Normally, the stomach performs an essential contribution to iron absorption by producing the vitamin B12 that is needed for this process. The stomach being absent, a Vitamin B12 injection is needed instead. This is given about about every six weeks; the frequency largely depends on one's absorption of the preparation, which is a synthesized compound of hydroxocobalamin delivered intramuscularly into the arm. The blood is regularly tested to determine the frequency of injections.

There is a need for plenty of vitamin C both before the operation and permanently thereafter. Vitamin C drinks are a good source, and the usual fresh fruit and vegetables even better. The absorption of vitamin C is necessary to that of the B12.

In the Long Term

I had to learn to live with the condition and make adjustments to lifestyle accordingly; otherwise, my body would most certainly remind me in no uncertain manner. I discovered very soon after the operation that if I ate too quickly, or ate too much in a short time, I would experience what is called 'dumping syndrome.'

Dumping Syndrome is the name given to the symptoms felt when food passes into the intestine too quickly. These can include nausea, some pain, light-headedness and palpitations. Sometimes the palpitations are a fast heartbeat, sometimes a 'strong' heartbeat that shakes the body. The blood chemistry is altered or unbalanced by the sudden influx of food; something similar to an effect of diabetes.

These can be very frightening episodes, lasting, on occasions, for hours once they have been 'triggered' by inappropriate eating habits.The answer is to avoid both overeating and eating too quickly.

Not Getting the Message

Another change to get used to post-operation, is that the patient is unaware of when he/she is 'full'. This is because the stomach has receptors that pass the message to the brain when one is full. No stomach, ergo, no message to the brain to let you know when to stop eating. The first indication is pain; and sometimes the dumping syndrome.

I found that even what would be a light breakfast to most people; that is, two Weetabix biscuits with semi-skimmed milk and one teaspoon of sugar, plus two cups of tea with milk and one sugar, triggered an episode of very fast palpitations. By trial and error I found the answer was to have only one wheat biscuit with a small amount of semi-skimmed milk and no sugar. Instead of tea, I found that one to one and a half mugs of water before eating breakfast, which could be repeated after about one hour to keep up my required intake of nourishment, eradicated the possibility of an episode of palpitations.

Present lifestyle

I now lead a reasonably normal lifestyle. My wife and I are keen walkers and only use the car for longer journeys.

Some people ask me whether I have a 'bag' (colostomy). The answer is no; colostomies are only used for bowel troubles. All my 're-plumbing' is contained within my body. You wouldn't be able to tell, except for the foot-long scar down the middle of my abdomen.

I no longer have the 'apparatus' to be able to be sick, if I ingest something disagreeable, it goes out the other way! I need to carefully guard against food poisoning. I avoid shellfish at all costs.

During a gastrectomy, surgeons try to retain as much of the upper part of the stomach, which is the main acid secreting area, as possible. This is, of course, dependent on the extent of the growth or damage to the stomach. Even with a complete gastrectomy, it is surprising how well the body adapts to digesting one's food quite efficiently via the secretions from the gall bladder and the liver, such as bile.

I can digest surprisingly more efficiently than I expected to after my 'gastrectomy', and so, even though my surgeon declined to enlighten me about the extent of my surgery, and told me that it was 'academic', I feel that I may have retained a degree of acid secreting tissue.

As regards nourishment I can sometimes lose a little weight through malabsorption, especially when I am due for my two monthly injection of vitamin B12 (ie six per year) or because I am neglecting to intake enough vitamin C via fruit juice and/or vegetables and fresh fruit. The heaviest I have ever been in my life, before and after the operations, is 10 stones 5 lbs. I am currently 9st 10lbs and 5' 10" tall.

Final Thoughts

I have to say that I feel very healthy, considering the fact that I underwent such a drastic procedure. I eat well, almost anything, but in small quantities. I experience appetite and hunger and enjoy my food. This should bring hope to all those who find themselves needing such surgical help.