Antrectomy

Antrectomy, also called antrectomy, is a surgical procedure that removes the antrum, the distal portion of the stomach near the pylorus. The antrum contains gastrin-producing G cells, and its removal reduces gastrin release and downstream acid secretion. The operation is usually performed as part of a distal gastrectomy, with restoration of gastrointestinal continuity through a reconstructive anastomosis.

Reconstruction after antrectomy typically involves Billroth I or Billroth II methods. In Billroth I (gastroduodenostomy), the stomach remnant is connected directly to the duodenum. In Billroth II (gastrojejunostomy), the stomach remnant is connected to the jejunum, with a separate biliary or afferent loop. Some centers use Roux-en-Y reconstructions, particularly when local anatomy or prior surgeries limit the available options. Antrectomy is therefore often performed for distal gastric resections where preservation of the proximal stomach is feasible.

Indications for antrectomy include peptic ulcer disease requiring surgical management (especially refractory gastric or duodenal ulcers or those with bleeding or obstruction), distal gastric cancer, and certain other conditions in which removal of the antrum provides therapeutic or staging benefits. With advances in medical therapy, including proton pump inhibitors and Helicobacter pylori eradication, the need for antrectomy has declined, and it is now reserved for selected cases where surgery is indicated or required for oncologic or severe ulcer-related reasons.

Complications can include anastomotic leakage, infection, bleeding, and delayed gastric emptying or dumping syndrome. Long-term risks may involve bile reflux, nutritional changes, and supervision for potential iron- or B12-related deficiencies depending on the extent of gastric resection.