Preservation of the celiac branch of the vagal nerve for pylorus-preserving gastrectomy: is it meaningful?

Furukawa, H; Ohashi, Manabu; Honda, Michitaka; Kumagai, Koshi; Nunobe, Souya; Sano, Takeshi; Hiki, Naoki

doi:10.1007/s10120-017-0776-8

Cited by 22 publications

(17 citation statements)

References 37 publications

(55 reference statements)

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“…In gastric cancer surgery, to achieve better lymph node dissection, the liver branch of the vagus nerve is inevitably damaged. Deletion or damage to the vagus nerve branch can result in impaired gallbladder emptying, which in turn may lead to gallstone formation [7, 8]. Also, radical gastrectomy usually involves Billroth II and Roux-en-Y techniques, which eliminate food passing through the duodenum, and may reduce secretion of cholecystokinin and gallbladder activity, promoting cholestasis and gallstone formation [2].…”

Section: Discussionmentioning

confidence: 99%

“…Lymph node dissection during radical gastrectomy is another possible risk factor for gallstone formation and subsequent cholecystectomy. Some studies have shown that the degree of lymph node dissection has an influence on gallstone formation [8]. More involved lymph node dissections are associated with a higher incidence of gallstones and acute cholecystitis following subsequent surgery than with limited or standard lymph node dissection.…”

Section: Discussionmentioning

confidence: 99%

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Clinical analysis of prophylactic cholecystectomy during gastrectomy for gastric cancer patients: a retrospective study of 1753 patients

et al. 2019

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Background Performance of gastrectomy in gastric cancer patients can lead to an increased incidence of cholecystolithiasis (CL) and a higher morbidity rate. However, the value of prophylactic cholecystectomy performed during gastric cancer surgery is still being debated. Methods We carried out a retrospective study on patients with gastric cancer who underwent subtotal or total gastrectomy, with preservation of the gallbladder or simultaneous cholecystectomy from January 2010 to March 2018. Results Cholecystolithiasis occurred in 152 of 1691 (8.98%) patients after gastric cancer surgery, with 45 (2.67%) patients undergoing subsequent cholecystectomy. Postoperative body mass index (BMI) decrease > 5% in 3 months was an independent risk factor for cholecystolithiasis [BMI decrease > 5%/≤5%: OR (95%CI): 1.812 (1.225–2.681), p = 0.003). Gastrectomy method and diabetes mellitus were independent risk factors for both cholecystolithiasis [gastrectomy method (no-Billroth I/Billroth I): OR (95%CI): 1.801 (1.097–2.959), p = 0.002; diabetes mellitus (yes/no): OR (95%CI): 1.544 (1.030–2.316), p = 0.036] and subsequent cholecystectomy [gastrectomy method (no-Billroth I/Billroth I): OR (95%CI): 5.432 (1.309–22.539), p = 0.020; diabetes mellitus (yes/no): OR (95%CI): 2.136 (1.106–4.125), p = 0.024]. Simultaneous cholecystectomy was performed in 62 of 1753 (3.5%) patients. The mortality and morbidity rates did not differ significantly between the combined surgery group and the gastrectomy only group (8.1% vs. 8.9 and 1.6% vs. 2.2%, respectively, p > 0.05). Conclusions Prophylactic cholecystectomy may be necessary in gastric cancer patients without Billroth I gastrectomy and with diabetes mellitus. Simultaneous cholecystectomy during gastric cancer surgery does not increase the postoperative mortality and morbidity rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical analysis of prophylactic cholecystectomy during gastrectomy for gastric cancer patients: a retrospective study of 1753 patients

et al. 2019

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“…This finding may represent a putative basis for the benefit of preserving the celiac branch during pylorus-preserving gastrectomy to reduce gastric stasis [2]. However, the benefit was not proven in retrospective analysis, which was likely a manifestation of delayed emptying after pylorus-preserving gastrectomy being primarily associated with a denervated antrum and the function of the pylorus, rather than the emptying function of the duodenum [16].…”

Section: Discussionmentioning

confidence: 99%

“…The celiac branch is also known to be associated with intestinal motility and diarrhea after gastrectomy. However, reports on the ability of celiac preservation to mitigate incidence of diarrhea or weight loss are conflicting [8121314151617]. These discrepancies could be partly explained by possible unnoticed injuries to the vagus nerve during surgery.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Neurophysiologic Testing of the Perigastric Vagus Nerve Branches to Evaluate Viability and Signals along Nerve Pathways during Gastrectomy

Kong

Kim

et al. 2019

J Gastric Cancer

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Purpose The perigastric vagus nerve may play an important role in preserving function after gastrectomy, and intraoperative neurophysiologic tests might represent a feasible method of evaluating the vagus nerve. The purpose of this study is to assess the feasibility of neurophysiologic evaluations of the function and viability of perigastric vagus nerve branches during gastrectomy. Materials and Methods Thirteen patients (1 open total gastrectomy, 1 laparoscopic total gastrectomy, and 11 laparoscopic distal gastrectomy) were prospectively enrolled. The hepatic and celiac branches of the vagus nerve were exposed, and grabbing type stimulation electrodes were applied as follows: 10–30 mA intensity, 4 trains, 1,000 µs/train, and 5× frequency. Visible myocontractile movement and electrical signals were monitored via needle probes before and after gastrectomy. Gastrointestinal symptoms were evaluated preoperatively and postoperatively at 3 weeks and 3 months, respectively. Results Responses were observed after stimulating the celiac branch in 10, 9, 10, and 6 patients in the antrum, pylorus, duodenum, and proximal jejunum, respectively. Ten patients responded to hepatic branch stimulation at the duodenum. After vagus-preserving distal gastrectomy, 2 patients lost responses to the celiac branch at the duodenum and jejunum (1 each), and 1 patient lost response to the hepatic branch at the duodenum. Significant procedure-related complications and meaningful postoperative diarrhea were not observed. Conclusions Intraoperative neurophysiologic testing seems to be a feasible methodology for monitoring the perigastric vagus nerves. Innervation of the duodenum via the celiac branch and postoperative preservation of the function of the vagus nerves were confirmed in most patients. Trial Registration Clinical Research Information Service Identifier: KCT0000823

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“…In gastric operations, reconstruction of the digestive tract may decrease passage of food through the duodenum, which probably decreases cholecystokinin secretion and reduces gallbladder motility, facilitating gallstone formation [ 12 ]. In addition, the hepatic branch of the vagus nerve is unavoidably damaged during surgical operations for gastric cancer because of the need for extended lymphadenectomy; moreover, the absence of or damage to the hepatic branch may cause dysregulation of gallbladder emptying, which may in turn contribute to gallstone formation [ 13 ]. Therefore, individualized and appropriate treatment strategies for CCL in patients with a history of gastrectomy are very valuable because such patients are often encountered in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of treatment strategies to cholecystocholedocholithiasis patients with previous subtotal or total gastrectomy: a retrospective cohort study

Zhang

Sun

et al. 2018

BMC Surg

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BackgroundPrevious gastrectomy can lead to an increased incidence of cholecystocholedocholithiasis (CCL) and increased morbidity rate. However, the appropriate treatment strategy for patients with CCL and a history of gastrectomy remains unclear.MethodsWe performed a retrospective cohort study of patients with CCL and a history of gastrectomy who underwent either one-stage laparoscopic common bile duct (CBD) exploration with stone clearance and laparoscopic cholecystectomy (LCBDE+LC) or two-stage endoscopic retrograde cholangiopancreatography followed by LC (ERCP+LC) from May 2010 to March 2018.ResultsThe success rate of ERCP for CBD stone clearance was 81.2% in patients with a history of Billroth I gastrectomy and 23.7% in patients with a history of Billroth II or Roux-en-Y esophagojejunostomy [χ2 = 97.67, P < 0.001, risk ratio (RR) = 3.43]. The success rate of second-step LC after successful ERCP for removal of CBD stones and the success rate of LCBDE+LC after ERCP treatment failure were 96.8 and 87.7%, respectively, in patients with preoperative intra-abdominal adhesion evaluation scores of ≤3 points. These success rates were 28.6 and 27.6%, respectively, in patients with scores of > 3 points (χ2 = 59.70, P < 0.001, RR = 3.38 and χ2 = 53.41, P < 0.001, RR = 3.27, respectively).ConclusionsBased on the results of this study, ERCP+LC seems to be an attractive strategy for treatment of CCL in patients with a history of Billroth I gastrectomy, and LCBDE+LC appears to be suitable for patients with a history of Billroth II or Roux-en-Y esophagojejunostomy. Preoperative evaluation of intra-abdominal adhesions helps to reduce the conversion rate of laparoscopic surgery.

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Preservation of the celiac branch of the vagal nerve for pylorus-preserving gastrectomy: is it meaningful?

Abstract: Preserving CBVN in LPPG for early gastric cancer is a feasible procedure. However, no clinical benefits of the preservation of the CBVN after LPPG are identified.

Cited by 22 publications

References 37 publications

Clinical analysis of prophylactic cholecystectomy during gastrectomy for gastric cancer patients: a retrospective study of 1753 patients

Clinical analysis of prophylactic cholecystectomy during gastrectomy for gastric cancer patients: a retrospective study of 1753 patients

Intraoperative Neurophysiologic Testing of the Perigastric Vagus Nerve Branches to Evaluate Viability and Signals along Nerve Pathways during Gastrectomy

Clinical analysis of treatment strategies to cholecystocholedocholithiasis patients with previous subtotal or total gastrectomy: a retrospective cohort study

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