The most effective treatment for gastric ulcers and duodenal ulcers that are not cured by systematic and standardized medication, gastric ulcers that are suspected to be cancerous (i.e., recalcitrant ulcers), or gastric ulcers that have complications such as pyloric obstruction, gastric perforation, and gastric hemorrhage, is to perform a gastric major resection (segmental resection). Gastrectomy is the removal of the distal 2/3 of the stomach, clinically known as distal gastrectomy. So why is the distal 2/3 of the stomach removed for ulcers? Will removing so much of the stomach affect digestion? Can’t we remove less? These are questions that patients are often confused about. To answer and understand these questions must first understand the physiological function of the stomach and its functional partition. (As shown in Figure 1) Figure 1: Gross anatomical pattern of the stomach As shown in Figure 1: the stomach is located in the left upper abdomen, divided into two upper and lower orifices, two curves of size, and two walls in front and back. The entrance of the stomach is called the cardia, which connects upward to the esophagus, and the exit of the stomach is called the pylorus, which connects downward to the duodenum. The upper edge of the stomach is called the lesser curvature and the lower edge is called the greater curvature. And it is divided into four regions, the cardia, the fundus, the body and the pylorus; the pylorus is further divided into left and right parts, the left side is called the pyloric sinus, also called the gastric sinus, and the right side is called the pyloric canal. The junction of the gastric body and sinus at the lesser curvature is called the gastric angle. Different anatomical regions of the gastric mucosa, its cellular distribution and its physiological functions are also different. The main physiological functions of the stomach: the stomach has five main physiological functions. 1. acceptance, storage of food function. 2. digestion and absorption function: through the peristalsis of the stomach and its secretion of gastric acid, pepsin, such as the synergistic effect of the food for mechanical and chemical digestion (primary digestion). 3. transportation and emptying function: the preliminary digestion, grinding of the food is discharged into the duodenum and the jejunum, for further digestion and absorption. 4. Defense function: the mucosal barrier of the stomach, gastric acid, secretory immunoglobulin lgG, lgA, and lymphoid tissue, etc., can prevent the invasion of pathogenic bacteria and foreign bodies. 5. Secretion function: the stomach can secrete gastric acid (hydrochloric acid), pepsin, pepsin, gastrin, gastric motility, growth inhibiting hormone, etc. The most important is the secretion of gastric acid. The most important is the secretion of gastric acid and pepsin. They are biochemicals indispensable for food digestion. Gastric acid (i.e. hydrochloric acid) is produced by the wall cells of the gastric mucosa, if the secretion of hydrochloric acid is too much, too much, in the common role of pepsin to cause damage to the gastric mucosa, so that the role of the local gastric mucosa ulceration and the formation of ulcers, which is the basic mechanism of gastric, duodenal ulcer formation. This is the basic mechanism for the formation of gastric and duodenal ulcers, which is really a “success or failure”! In recent years, the discovery of conditional pathogenic bacteria gastric Helicobacter pylori also at this time to take advantage of the situation, involved in the destruction of the gastric mucosa activities. (As shown in Figure 2) Figure 2: Diagram of our surgically resected giant stomach As seen more clearly in the pattern diagram below (Figure 3), most of the hydrochloric acid-secreting mural cells of the gastric mucosa are distributed in the distal 2/3 region of the stomach; in addition, the gastric mucosal G-cells of the gastric antrum also secrete gastrin, which causes secretion of gastric acid through the neurosomatous reflexes. Furthermore, gastroduodenal ulcers almost always occur in the distal 2/3 of the stomach. The regional distribution of mural cells of the gastric mucosa that secrete gastric acid The rationale behind the need to resect the distal 2/3 region of the stomach for surgery of gastric and duodenal ulcers with surgical indications is here. The distal gastric resection can be said to kill several birds with one stone: 1. resection of most of the wall cells of the gastric mucosa secretes gastric acid, so that the secretion of gastric acid is significantly reduced, which eliminates the most important risk factors for the formation of gastric and duodenal ulcers; 2. resection of the gastrin-secreting G-cells of the gastric sinus mucosa, removing the accomplices of gastric acid secretion; 3. the main thing is to excise the ulcer foci, eliminating the complications of cancerous ulcers, hemorrhage, perforation, and pyloric obstruction. pyloric obstruction and other complications. If the scope of gastric resection is not enough and only half or part of it is resected, then there are more residual wall cells of the gastric mucosa that secrete gastric acid, which will cause ulcer recurrence in the residual stomach, and ulcer and bleeding situation at the site of gastrointestinal anastomosis for gastrointestinal reconstruction, which strictly speaking means the failure of the surgery. The effect of major gastrectomy on the patient’s digestive function is temporary, and after the operation it is necessary to pay attention to the diet, eat small, frequent meals (4-5 times a day), and eat both nutritious and well-digested food. Gradually transition from full-fluid food to semi-fluid food and general food. Generally, about one year after the distal gastrectomy, the remaining 1/3 of the remaining stomach will grow to a size close to the original normal size and gradually restore normal digestive function. Therefore, there is no need to worry. Consult Now