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Impact of vagus nerve integrity testing on surgical management in patients with previous operations with potential risk of vagal injury

Abstract

Background

Thoracic and foregut operations can cause vagal nerve injury resulting in delayed gastric emptying or gastroparesis. However, the cause of gastroparesis in these patients is not always from a vagal injury. We hypothesize that vagal nerve integrity (VNI) testing may better define who has vagal nerve dysfunction. This information may change subsequent operations. The aim of this study was to evaluate the impact of VNI testing in patients with prior thoracic or gastric surgery.

Methods

From January 2014 to December 2017, patients who had previous operations with the potential risk of vagal injury and had VNI testing were reviewed. Excluded patients were those with no plan for a second operation or the second operation was only for gastroparesis. The main outcome was the percentage of operations altered due to the results of VNI testing.

Results

Twelve patients (eight females) were included. Ages ranged from 37 to 77 years. VNI results were compatible with vagal injury in eight patients (67%). VNI test results altered subsequent operative plans in 41.7% (5/12). Pyloroplasty was done in addition to fundoplication in two patients. Plans for hiatal hernia repair with or without redo-fundoplication in three patients were changed by an additional pyloroplasty in one patient and partial gastrectomy with Roux-en-Y reconstruction in two patients. All patients who had secondary surgery had resolution of symptoms and improvement in objective testing.

Conclusion

The addition of VNI testing in patients with a previous potential risk of vagal nerve injury may help the surgeon select the appropriate secondary operation.

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Acknowledgements

The authors would like to thank all staff personnel of Loyola University Medical Center, Maywood, IL, U.S.A. who helped with the data retrieval and provided the essential information. We would also like to thank Mr. Glenn Shingledecker in the Office of International Affairs, Faculty of Medicine, Prince of Songkla University for the proofreading and language support.

Author information

Correspondence to Bipan Chand.

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Disclosures

Kamthorn Yolsuriyanwong, Eric Marcotte, Mukund Venu and Bipan Chand have no conflicts of interest or financial ties to disclose.

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Yolsuriyanwong, K., Marcotte, E., Venu, M. et al. Impact of vagus nerve integrity testing on surgical management in patients with previous operations with potential risk of vagal injury. Surg Endosc 33, 2620–2628 (2019). https://doi.org/10.1007/s00464-018-6562-9

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Keywords

  • Vagus nerve integrity
  • Vagus nerve injury
  • Delayed gastric emptying
  • Gastroparesis
  • Postsurgical gastroparesis
  • Pancreatic polypeptide