Vagus nerve-preserving versus conventional laparoscopic splenectomy and azygoportal disconnection
Conventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to the vagal nerve. We have developed vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection (VLSD). This study aimed to evaluate whether VLSD is effective and safe, and to determine whether a reduction in the incidence of postoperative complications improves postoperative quality of life compared with CLSD.
We retrospectively evaluated outcomes in 72 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism who underwent CLSD (n = 40) or VLSD (n = 32) between April 2015 and December 2016. Their demographic, intraoperative, and postoperative variables were compared.
No patients required conversion to laparotomy in CLSD and VLSD. There was no difference in estimated intraoperative blood loss, volume of intraoperative blood transfused, time to first flatus, time to off-bed activity, and postoperative hospital stay between the two groups. VLSD was associated with a shorter operation time (P = 0.020) and less postoperative complications (P < 0.0001), including less diarrhea (P < 0.0001), epigastric fullness (P < 0.0001), and delayed gastric emptying (P < 0.0001), compared with CLSD. With VLSD, there was a significant increase in body weight and plasma albumin levels at 6 months postoperatively compared with preoperative values (all P < 0.05). The curative effect of improving esophageal/gastric variceal bleeding was similar in the groups.
VLSD is effective and safe for reducing the incidence of postoperative complications, contributing to improving postoperative quality of life.
KeywordsLiver cirrhosis Portal hypertension Laparoscopy Delayed gastric emptying Vagus nerve
This work was supported by the Scientific Research Subject of Jiangsu Province Health Department (No. H201661) and the Project of Invigorating Health Care through Science, Technology and Education: Jiangsu Provincial Medical Youth Talent (QNRC2016331).
Compliance with ethical standards
Drs. Dou-Sheng Bai, Ping Chen, Sheng-Jie Jin, Jian-Jun Qian, and Guo-Qing Jiang have no conflicts of interest or financial ties to disclose.
- 10.Tomita R, Tanjoh K, Fujisaki S (2004) Novel operative technique for vagal nerveand pyloric sphincter-preserving distal gastrectomy reconstructed by interposition of a 5 cm jejunal J pouch with a 3 cm jejunal conduit for early gastric cancer and postoperative quality of life 5 years after operation. World J Surg 28:766–774CrossRefPubMedGoogle Scholar
- 12.Tomita R, Fujisaki S, Tanjoh K, Fukuzawa M (2001) Operative technique on nearly total gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of vagal nerve, lower esophageal sphincter, and pyloric sphincter for early gastric cancer. World J Surg 25:1524–1531CrossRefPubMedGoogle Scholar
- 13.Tomita R, Fujisaki S, Tanjoh K, Fukuzawa M (2003) Studies on gastrointestinal hormone and jejunal nterdigestive migrating motor complex in patients with or without early dumping syndrome after total gastrectomy with Roux-en-Y reconstruction for early gastric cancer. Am J Surg 185:354–359CrossRefPubMedGoogle Scholar
- 15.Kim SM, Cho J, Kang D, Oh SJ, Kim AR, Sohn TS, Noh JH, Kim S (2016) A randomized controlled trial of vagus nerve-preserving distal gastrectomy versus conventional distal gastrectomy for postoperative quality of life in early stage gastric cancer patients. Ann Surg 263:1079–1084CrossRefPubMedGoogle Scholar