Clinical Efficacy of the Preservation of the Hepatic Branch of the Vagus Nerve on Delayed Gastric Emptying After Laparoscopic Pancreaticoduodenectomy

Xu, Li; Qin, Tingting; Zhu, Feng; Wang, Min; Dang, Chao; He, Li; Pan, Shutao; Liu, Yuhui; Yin, Taoyuan; Feng, Yecheng; Wang, Xin; Yu, Yahong; Shen, Ming; Lu, Xingpei; Chen, Yongjun; Jiang, Li; Shi, Chenjian; Qin, Renyi

doi:10.1007/s11605-021-05024-y

Cited by 9 publications

(3 citation statements)

References 41 publications

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“…The exact mechanisms of DGE are still unclear and are mostly multifactorial results involving vagal denervation. A recent retrospective study demonstrated that preservation of the hepatic branch of the vagus nerve could help reduce the incidence of DGE during LPD ( 77 ). These results are likely to be related to fine dissection and meticulous manipulation, as laparoscopic surgery offers a magnified view that facilitates precise identification of nerves and effective prevention of excessive nerve injury.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic versus open pancreaticoduodenectomy for pancreatic and periampullary tumor: A meta-analysis of randomized controlled trials and non-randomized comparative studies

Yan

Hua²,

Chen³

et al. 2023

Front. Oncol.

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ObjectiveThis meta-analysis compares the perioperative outcomes of laparoscopic pancreaticoduodenectomy (LPD) to those of open pancreaticoduodenectomy (OPD) for pancreatic and periampullary tumors.BackgroundLPD has been increasingly applied in the treatment of pancreatic and periampullary tumors. However, the perioperative outcomes of LPD versus OPD are still controversial.MethodsPubMed, Web of Science, EMBASE, and the Cochrane Library were searched to identify randomized controlled trials (RCTs) and non-randomized comparative trials (NRCTs) comparing LPD versus OPD for pancreatic and periampullary tumors. The main outcomes were mortality, morbidity, serious complications, and hospital stay. The secondary outcomes were operative time, blood loss, transfusion, postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH), bile leak (BL), delayed gastric emptying (DGE), lymph nodes harvested, R0 resection, reoperation, and readmission. RCTs were evaluated by the Cochrane risk-of-bias tool. NRCTs were assessed using a modified tool from the Methodological Index for Non-randomized Studies. Data were pooled as odds ratio (OR) or mean difference (MD). This study was registered at PROSPERO (CRD42022338832).ResultsFour RCTs and 35 NRCTs concerning a total of 40,230 patients (4,262 LPD and 35,968 OPD) were included. Meta-analyses showed no significant differences in mortality (OR 0.91, p = 0.35), serious complications (OR 0.97, p = 0.74), POPF (OR 0.93, p = 0.29), PPH (OR 1.10, p = 0.42), BL (OR 1.28, p = 0.22), harvested lymph nodes (MD 0.66, p = 0.09), reoperation (OR 1.10, p = 0.41), and readmission (OR 0.95, p = 0.46) between LPD and OPD. Operative time was significantly longer for LPD (MD 85.59 min, p < 0.00001), whereas overall morbidity (OR 0.80, p < 0.00001), hospital stay (MD −2.32 days, p < 0.00001), blood loss (MD −173.84 ml, p < 0.00001), transfusion (OR 0.62, p = 0.0002), and DGE (OR 0.78, p = 0.002) were reduced for LPD. The R0 rate was higher for LPD (OR 1.25, p = 0.001).ConclusionsLPD is associated with non-inferior short-term surgical outcomes and oncologic adequacy compared to OPD when performed by experienced surgeons at large centers. LPD may result in reduced overall morbidity, blood loss, transfusion, and DGE, but longer operative time. Further RCTs should address the potential advantages of LPD over OPD.Systematic review registrationPROSPERO, identifier CRD42022338832.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic versus open pancreaticoduodenectomy for pancreatic and periampullary tumor: A meta-analysis of randomized controlled trials and non-randomized comparative studies

Yan

Hua²,

Chen³

et al. 2023

Front. Oncol.

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“…These findings revealed that LGV ligation was a risk factor for DGE after SSPPD but was unrelated to the reconstruction methods. Regarding the possibility of damage to the vagus nerve in DGE after SSPPD, Xu et al suggested that preservation of the hepatic branches of the vagus nerve reduces the development of DGE after laparoscopic PD [23]. Nevertheless, the LGV runs closer to the caudal side of the hepatic branch of the vagus nerve, indicating that LGV ligation might be related to the damage of the left gastric artery plexus from the posterior trunk of the vagus nerve anatomically [24].…”

Section: Discussionmentioning

confidence: 99%

Ligation of left gastric vein may cause delayed gastric emptying after pancreatoduodenectomy: a retrospective study

et al. 2022

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Background This study aimed to determine which running pattern of the left gastric vein (LGV) is most frequently ligated in subtotal stomach-preserving pancreatoduodenectomy (SSPPD) and how LGV ligation affects delayed gastric emptying (DGE) after SSPPD. Methods We retrospectively analysed 105 patients who underwent SSPPD between January 2016 and September 2021. We classified the running pattern of LGV as follows: type 1 runs dorsal to the common hepatic artery (CHA) or splenic artery (SpA) to join the portal vein (PV), type 2 runs dorsal to the CHA or SpA and joins the splenic vein, type 3 runs ventral to the CHA or SpA and joins the PV, and type 4 runs ventral to the CHA or SpA and joins the SpV. Univariate and multivariate analyses were used to identify differences between patients with and without DGE after SSPPD. Results Type 1 LGV running pattern was observed in 47 cases (44.8%), type 2 in 23 (21.9%), type 3 in 12 (11.4%), and type 4 in 23 (21.9%). The ligation rate was significantly higher in type 3 (75.0%) LGVs (p < 0.0001). Preoperative obstructive jaundice (p = 0.0306), LGV ligation (p < 0.0001), grade B or C pancreatic fistula (p = 0.0116), and sepsis (p = 0.0123) were risk factors for DGE in the univariate analysis. Multivariate analysis showed that LGV ligation was an independent risk factor for DGE (odds ratio: 13.60, 95% confidence interval: 3.80–48.68, p < 0.0001). Conclusion Type 3 LGVs are often ligated because they impede lymph node dissection; however, LGV preservation may reduce the occurrence of DGE after SSPPD.

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“…7) The correlation between DGE incidence and pancreatic texture was not statistically significant (P = .27) (log OR = 0.20, 95% CI: −0.16 to 0.55). (The forest plots of analysis without significant difference had Case-control study Japan Lee et al [18] 2021 108 25/83 66.28 59/49 2010-2016 Case-control study South Korea Snyder et al [14] 2020 10249 1702/8547 64.47 5498/4751 2014-2016 Retrospective cohort study USA Gagnière et al [19] 2018 100 31/69 66.26 56/44 2011-2014 Case-control study France Arango et al [20] 2020 724 197/527 62 405/319 2011-2019 Retrospective cohort study USA Degisors et al [21] 2021 311 31/280 57.33 127/184 2012-2017 Systematic review France Li et al [22] 2021 274 91/183 55.83 153/121 2014-2019 Retrospective cohort study China Hackert et al [5] 2018 been supplemented in the Additional file, http://links.lww. com/JP9/A24.…”

Section: Incidence Risk Of Dgementioning

confidence: 99%

Perioperative risk factors for delayed gastric emptying after pancreaticoduodenectomy: a meta-analysis of the complications

Deng

Niu

Han

et al. 2023

Journal of Pancreatology

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To evaluate the correlation between the incidence of delayed gastric emptying (DGE) in pancreaticoduodenectomy (PD) and the perioperative possible risk factors. Methods: We searched PubMed, Embase, Cochrane Library, and Medline for studies describing complications related to PD from 2018 to 2022. Statistical analysis was performed using Stata/SE16.0 software. Results: In 6 retrospective studies, 1 systematic review, and 1 randomized controlled trial (RCT) experiment, 12,419 patients (2174 and 10,245 patients, respectively, in DGE and no delayed gastric emptying [NDGE] groups). The preoperative American Society of Anesthesiologists (ASA) score between DGE and NDGE groups (log odds ratio [OR] = 0.23, 95% credible interval [CI]: 0.11-0.35, P < .01), operation time (mean diff. = 21.87, 95% CI: 15.96-27.78, P < .01), estimated intraoperative blood loss (EIBL; mean diff. = 70.67, 95% CI: 17.75-123.58, P < .05), postoperative pancreatic fistula (POPF) (log OR = 0.85, 95% CI: 0.24-1.46, P < .05) were statistically significant. No significant differences in preoperative body mass index (BMI), preoperative biliary drainage, and pancreatic texture were observed (P > .05). Conclusion:The incidence of DGE is significantly correlated with the operation time, preoperative ASA score, POPF, and EIBL, which suggests that the surgeon should thoroughly evaluate the patient through adequate preoperative examination before the operation. Finally, standardized practice and perfect technology are undoubtedly necessary to reduce complications.

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Clinical Efficacy of the Preservation of the Hepatic Branch of the Vagus Nerve on Delayed Gastric Emptying After Laparoscopic Pancreaticoduodenectomy

Cited by 9 publications

References 41 publications

Laparoscopic versus open pancreaticoduodenectomy for pancreatic and periampullary tumor: A meta-analysis of randomized controlled trials and non-randomized comparative studies

Laparoscopic versus open pancreaticoduodenectomy for pancreatic and periampullary tumor: A meta-analysis of randomized controlled trials and non-randomized comparative studies

Ligation of left gastric vein may cause delayed gastric emptying after pancreatoduodenectomy: a retrospective study

Perioperative risk factors for delayed gastric emptying after pancreaticoduodenectomy: a meta-analysis of the complications

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