A client has been diagnosed with adenocarcinoma of the stomach and is scheduled to undergo a subtotal gastrectomy (Billroth II procedure). During preoperative teaching, the nurse is reinforcing information about the procedure. Which of the following explanations is most accurate?
A. The procedure will result in enlargement of the pyloric sphincter.
B. The procedure will result in anastomosis of the gastric stump to the jejunum.
C. The procedure will result in removal of the duodenum.
D. The procedure will result in repositioning of the vagus nerve.
Correct Answer: B. The procedure will result in anastomosis of the gastric stump to the jejunum.
A Billroth II procedure bypasses the duodenum and connects the gastric stump directly to the jejunum. The pyloric sphincter is removed, along with some of the stomach fundus. If the stomach cannot be reconnected to the duodenum, a Billroth II is performed, in which an opening hole is made in the next section of the small intestine, the jejunum, and the stomach attached at that opening.
Option A: A pyloromyotomy is an operation to loosen the tight muscle causing the blockage between the stomach and small intestine. During the operation, the surgeon cuts the tight muscle between the stomach and small intestine. This loosens the muscle so the stomach can empty and food will be able to pass easily into the small intestine.
Option C: The Whipple procedure (pancreaticoduodenectomy) is an operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder, and the bile duct. The remaining organs are reattached to allow the client to digest food normally after surgery.
Option D: Billroth II gastrojejunostomy is a procedure that has been performed for tumor or severe ulcer disease in the distal stomach. There are many variations on the procedure, but they generally involve resection of the diseased portion of the distal stomach and a side-to-side anastomosis of the residual stomach to jejunum through the transverse mesocolon. It can be performed with either an antecolic or a retrocolic anastomosis.
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