How Stomach Surgery Can Help with Gastric Diseases
There are a variety of different types of diseases that can affect the stomach which include gastric tumors (both malignant and benign), peptic ulcers, and gastroparesis to name a few. The Khalili Center has several general surgeons specializing in stomach repairs, laparoscopic stomach cancer treatment, and restrictive procedures.
Our general surgeons are experts in the endoscopic and laparoscopic surgical management of stomach diseases. The surgeons are specialists in peptic ulcer surgeries, interventional surgeries, and weight-loss procedures that can be used to treat the disease.
Top Stomach Specialists in Los Angeles
Our founder, Dr. Theodore M. Khalili, MD, FACS, is an expert in advanced general surgery procedures. Dr. Khalili served his internship and residency in general surgery at the Cedars-Sinai Medical Center. There, he also served his fellowship in surgical critical care and helped develop the weight-loss program.
Dr. Khalili is a pioneer in advanced surgical techniques. In 2002, he performed the first robotic-assisted gastric bypass in the United States. Gastric bypass is a bariatric surgery procedure commonly used to treat gastroparesis(1). Dr. Khalili has performed over 8,000 advanced bariatric procedures and laparoscopic surgeries in his career.
He is also a member of several organizations, including the Society of American Gastrointestinal Endoscopic Surgeons and the American Society of Bariatric Procedures. Our general and bariatric surgeons are graduates and professors from prestigious medical schools, such as the University of California, Los Angeles (UCLA) and University of California Irvine (UCI).
Our surgeons are also experts in weight-loss procedures, such as gastric bypass surgery, gastric sleeve surgery (sleeve gastrectomy), duodenal switch, and Lap-Band surgery (gastric band).
Read more about our doctors and learn how their expertise led to many success stories. To find out more about other general procedures at the Khalili Center, click here.Watch the video
My name is Dr. Theodore Khalili, surgeon and founder of Weight Loss Surgery of Southern California. I founded the Center because I have dedicated my life-long professional work to patient care. My approach to patient-centric partnerships and service-oriented facilities offer a comprehensive and holistic approach to bariatric treatment – all in one place.
I believe that patient care does not end right after surgery – it’s only the beginning. I founded the Center to give patients access to a supportive community that guides them through each step of the weight loss journey. We work with a team of registered dieticians, psychologists and general doctors to create tailored, best-in-class care available.Read more
The Khalili Center Aftercare Program
Our patient care team sets us apart from other general surgery and weight-loss centers. Our team consists of doctors and healthcare providers who believe in maintaining partnerships with our old and new patients. Our aftercare program will provide you with extensive support because the success of your recovery is important to us.
Our surgery center is not just for procedures. We are one of the few medical centers in Southern California that allow patients access to our doctors and support staff.
Our comprehensive program includes the following:
- Regular follow-ups
- Monthly walks with our doctors
- Consultation with our registered dietitian
- Counsel sessions with our psychologist
- Community activities
- Support groups
Is Stomach Surgery
Right for You?
Non-surgical treatments and lifestyle changes sometimes fail to improve stomach diseases, such as peptic ulcers, gastric tumors, and gastroparesis.
Our doctors will recommend endoscopic and laparoscopic procedures to repair the organ. In some cases, the surgeon will recommend bariatric (weight-loss) surgery to treat your condition.
Advanced stomach cancers will need a gastrectomy, a procedure in which the surgeon removes a part of the stomach(2).
Before the surgery, you will undergo an extensive screening process, examinations, and blood tests. Our surgeons will study results and recommend the appropriate treatment options.
Benefits of Stomach Surgery
Repairing perforated ulcers using a laparoscopic technique has been proven safe and effective, requiring less recovery time and shorter hospital stay(3). The procedure uses small incisions as insertion sides for the laparoscope (camera) and surgical tools. When a portion of the stomach is beyond repair, doctors will perform a bariatric procedure. Depending on the condition, our surgeons will recommend a bariatric surgery best suited to treat the disease.
Doctors observed that medication-resistant gastroparesis could be treated with gastric bypass. Patients no longer had to take medication after the procedure(4). Furthermore, subtotal and total gastrectomies have been proven to decrease patients’ mortality rates with stomach cancer. The surgical procedure increased the quality of life among patients with advanced tumors(5).
Other benefits associated with bariatric or weight-loss surgery are the following:
- Significant weight loss due to fewer calories
- Lower risk for heart disease and stroke
- Reduced high blood pressure
- Lower risk Nonalcoholic fatty liver disease
- Reduced sleep apnea
Lower risk or reduced symptoms of Type 2 diabetes
Our surgeon will conduct a final examination by using an endoscope to look inside the stomach. An endoscope is a small camera attached to a flexible tube. During this procedure, mild sedatives will be used to put the patient to sleep. Our dietitian will provide pre-surgery guidelines, such as diet and pain medication restrictions. These restrictions are imposed on patients to bring the best possible outcomes from the surgery.
Even though stomach surgeries are done laparoscopically, they are still considered major procedures. Because recovery will take a few weeks, you must make arrangements to have someone assist you with hospital discharge and daily tasks at home.
Several days before the surgery, our doctors will ask you to follow these guidelines:
- Drink only clear liquids, laxatives, and enemas days before the surgery.
- The midnight before the operation, you must not eat or anything, except for medications prescribed by the surgeon. You are allowed a sip of water in the morning of the surgery.
- Aspirin, blood thinners, anti-inflammatory medications, and vitamin E must be discontinued days before the surgery.
- Smokers will be asked to quit smoking.
Life After a Stomach Surgery
You can expect an improved life quality after the operation due to relief from gastric disease symptoms. In terms of medication, some gastroparesis patients are no longer required to take medicine(6). However, patients with peptic ulcers will need to continue medication or treatment as instructed by doctors.
After a bariatric surgery, your food intake will be significantly affected. Having a small pouch or no stomach requires a small amount of food. You will have to take smaller and more frequent meals for the rest of your life. The lower amount of calories leads to long-term weight loss.
The smaller stomach pouch also leads to malabsorption of nutrients. Our dietitian will advise you to take supplements, including vitamin B12, vitamin D, vitamin C, calcium, and iron. You must make some lifestyle changes for the long-term success of the operation. Healthy eating and regular exercise, as instructed by doctors, must be maintained. Cancer patients who underwent a subtotal or total gastrectomy will need to continue cancer treatments. Depending on the oncologist’s recommendations, these treatments will vary from radiation therapy, chemotherapy, and immunotherapy.
What Are the Risks of Stomach Surgery?
Like any major surgery, bariatric surgeries may present some risks and side effects. The Khalili Center is committed to providing all the information that one may need.
Risks for surgery complications may vary depending on the condition’s severity(7):
- Gastrointestinal bleeding
- Blood clots
- Lung or breathing problems
- Reactions to general anesthesia
- Gastrointestinal leak
- Dumping syndrome (nausea, vomiting, abdominal cramps)
- Death (rare)
What Should I Expect During Recovery?
Recovery after a laparoscopic procedure is faster compared to open surgeries. The small incisions on the abdomen are easier to clean and maintain. You will have less pain after the procedure.
Recovery for stomach surgery depends on how well the patient responds to the operation. If you had bariatric surgery, the recovery could take around six to eight weeks.
After a stomach surgery, your digestive system needs to recuperate. You will be allowed to take only clear liquids for two days to enable your new stomach to heal. The nurse will also ask you to take a few steps.
Once you are discharged, you can take on a full liquid diet, such as broth and unsweetened juices. By the third week, you can transition to pureed foods and occasional crackers. Most patients go back to work around two to three weeks after surgery. You can transition to soft foods like cottage cheese, porridge, and mashed potatoes by the fourth week. You will also be advised to take short walks.
However, you must avoid doing any strenuous activities or heavy lifting for six weeks following your surgery. Barring any complications, you can be fully-recovered around eight weeks after your surgery and carry on with your normal activities.
Will Insurance Cover a Stomach Surgery?
The Khalili Center is accredited by several insurance groups. All of our procedures are eligible for payment plans through Prosper Healthcare Lending. The financing program helps patients afford treatments through alternative payment solutions. You may inquire about the procedure cost through our customer care team.
Understanding Stomach Diseases
Most stomach diseases can be treated with minimally-invasive surgery. However, the technique will depend on the severity of the condition.
There are two types of peptic ulcer diseases. Gastric ulcers are open sores on the lining inside the stomach, while duodenal ulcers sores on the upper part of the small intestine (duodenum). Peptic ulcer symptoms include abdominal pain, bloating, belching, and intolerance of fatty foods. These symptoms are also accompanied by vomiting and nausea(8).
Peptic ulcers can be caused by helicobacter pylori infection. H.pylori infection causes inflammation (peritonitis and gastritis) or damages the lining of the stomach, allowing the gastric acid to create an open sore.
The prolonged use of ibuprofen and other non-steroidal anti-inflammatory drugs (NSAID) is another common cause of peptic ulcers. Peptic ulcer risk factors include smoking, stress, spicy food, and alcohol consumption(9).
Management of peptic ulcer diseases is possible with stomach acid secretion medication, such as proton pump inhibitors (PPI), H2 blockers, and acid neutralizers (antacids). H.pylori infection can be managed by a triple therapy approach consisting of PPI, amoxicillin, and clarithromycin for seven to 14 days.
However, even with reduced acid production, around 5 to 10% of stomach ulcer cases will require emergency surgery(10). Laparoscopic peptic ulcer treatment can combine two forms of surgical intervention, such as pyloroplasty and vagotomy.
A pyloroplasty relaxes the pyloric sphincter (the opening from the stomach to the small intestine). Meanwhile, a truncal vagotomy removes the vagus nerve (a nerve that runs from the brain to the gastrointestinal tract).
Perforated peptic ulcers (bleeding ulcers) beyond repair will require a partial gastrectomy or total gastrectomy (removal of the stomach).
The stomach muscles are essential during digestion. When you have gastroparesis, the stomach muscles are weak and unable to promote proper digestion. Gastroparesis can decrease the life quality of individuals. Gastroparesis patients’ health problems include dehydration, malnutrition, low blood sugar, indigestion, acid reflux, heartburn, nausea, and vomiting.
Clinical features of gastroparesis patients vary. Many gastroparesis patients suffer from obesity(11). It is well-observed that 46% of gastroparesis patients have a body mass index (BMI) of 30 or over. Meanwhile, a mean 8% of patients are underweight with a BMI lower than 18(11).
Gastroparesis can be treated by medicine or mild electric shocks. However, if the condition is resistant to non-surgical treatments, the doctor can recommend roux-en-y gastric bypass surgery. Gastric bypass is a procedure that separates a small pouch (fundus) from the rest of the stomach, leading the food directly to the small intestine.
Malignant tumors on the stomach lining will require surgery. Gastric cancer symptoms include stomach pain, bloating, severe indigestion, vomiting, and unintentional weight loss. The surgery will depend on the cancer diagnosis. The cancer cells on the stomach wall can be treated with endoscopic mucosal resection during the early stages.
Meanwhile, late-stage stomach cancer that has affected nearby organs will require subtotal gastrectomy (partial stomach removal) or total gastrectomy (removal of the entire stomach). After stomach cancer surgery, cancer patients will be referred back to the oncologist for further cancer treatment.
These are the stages of stomach cancer:
- Stage I – cancer cells in the top layer stomach wall and nearby lymph nodes
- Stage II – cancer deep in the muscle layer of the esophagus, stomach wall, and lymph nodes
- Stage III – cancer cells have grown through organs, digestive tract, nearby structures, and lymph nodes
- Stage IV – cancer cells have spread to distant areas of the body
- Papasavas, P. K., Ng, J. S., Stone, A. M., Ajayi, O. A., Muddasani, K. P., & Tishler, D. S. (2014). Gastric bypass surgery as treatment of recalcitrant gastroparesis. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 10(5), 795–799. https://doi.org/10.1016/j.soard.2014.01.013
- The Mayo Clinic Stomach Cancer Overview. Retrieved from https://www.mayoclinic.org/diseases-conditions/stomach-cancer/diagnosis-treatment/drc-20352443#:~:text=Chemotherapy%20is%20also%20used%20after,help%20relieve%20signs%20and%20symptoms.
- Siu, W. T., Leong, H. T., Law, B. K., Chau, C. H., Li, A. C., Fung, K. H., Tai, Y. P., & Li, M. K. (2002). Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Annals of surgery, 235(3), 313–319. https://doi.org/10.1097/00000658-200203000-00001
- Pavlos K. Papasavas, Janet S. Ng, Andrea M. Stone, Olayemi A. Ajayi, Kiranmayi P. Muddasani, Darren S. Tishler, Gastric bypass surgery as a treatment of recalcitrant gastroparesis, Surgery for Obesity and Related Diseases, Volume 10, Issue 5, 2014, Pages 795-799, ISSN 1550-7289, https://doi.org/10.1016/j.soard.2014.01.013.
- da Costa, W. L., Jr, Coimbra, F. J., Ribeiro, H. S., Diniz, A. L., de Godoy, A. L., de Farias, I. C., Begnami, M. D., & Soares, F. A. (2015). Total gastrectomy for gastric cancer: an analysis of postoperative and long-term outcomes through time: results of 413 consecutive cases in a single cancer center. Annals of surgical oncology, 22(3), 750–757. https://doi.org/10.1245/s10434-014-4212-6
- Papasavas PK, Ng JS, Stone AM, Ajayi OA, Muddasani KP, Tishler DS. Gastric bypass surgery as treatment of recalcitrant gastroparesis. Surg Obes Relat Dis. 2014;10(5):795-799. doi:10.1016/j.soard.2014.01.013
- Bariatric Surgery Risks. Retrieved from https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258
- Peptic Ulcer Overview. Retrieved from https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223#:~:text=The%20most%20common%20causes%20of,do%20not%20cause%20peptic%20ulcers.
- Lee, C. W., & Sarosi, G. A., Jr (2011). Emergency ulcer surgery. The Surgical clinics of North America, 91(5), 1001–1013. https://doi.org/10.1016/j.suc.2011.06.008
- Boaz M, Kislov J, Dickman R, Wainstein J. Obesity and symptoms suggestive of gastroparesis in patients with type 2 diabetes and neuropathy. J Diabetes Complications. 2011;25(5):325-328. doi:10.1016/j.jdiacomp.2011.06.005
- Parkman, H. P., Yates, K., Hasler, W. L., Nguyen, L., Pasricha, P. J., Snape, W. J., Farrugia, G., Koch, K. L., Abell, T. L., McCallum, R. W., Lee, L., Unalp-Arida, A., Tonascia, J., Hamilton, F., & National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium (2011). Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity. Gastroenterology, 140(1), 101–115. https://doi.org/10.1053/j.gastro.2010.10.015
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