Preservation of hepatic branch of the vagus nerve reduces the risk of gallstone formation after gastrectomy

Abstract

Background Injury to the vagus nerve has been proposed to be associated with occurrence of gallstones after gastrectomy. We investigated the effect of preservation of hepatic branch of the vagus nerve on prevention of gallstones during laparoscopic distal (LDG) and pylorus-preserving gastrectomy (LPPG). Methods Preservation of the vagus nerve was reviewed of cT1N0M0 gastric cancer patients underwent LDG (n = 323) and LPPG (n = 144) during 2016-2017. Presence of gallstones was evaluated by ultrasonography (US) and computed tomography (CT). Incidences of gallstones were compared between the nerve preserved (h-DG, h-PPG) group and sacrificed (s-DG, s-PPG) group. Clinicopathological features were also compared. Results The 3-year cumulative incidence of gallstones was lower in the h-DG (2.7%, n = 85) than the s-DG (14.6%, n = 238) (p = 0.017) and lower in the h-PPG (1.6%, n = 123) than the s-PPG (12.9%, n = 21) (p = 0.004). Overall postoperative complication rate was similar between the h-DG and s-DG (p = 0.861) as well as between the h-PPG and s-PPG (p = 0.768). The number of retrieved lymph nodes station #1 and 3-year recurrence-free survival were not significantly different between the preserved group and sacrificed group. Injury to the vagus nerve (p = 0.001) and high body mass index (BMI) (≥ 27.5 kg/m 2 ) (p = 0.040) were found to be independent risk factors of gallstone formation in multivariate analysis. Conclusions Preservation of hepatic branch of the vagus nerve can be recommended for LDG as well as LPPG of early gastric cancer patients to reduce postoperative gallstone formation.

Function-Preserving Gastrectomy for Early Gastric Cancer

“…The cumulative incidence of gallstones was also reported to be lower in PPG than in DG [ 31 ]. The preservation of the hepatic branch of the vagus nerve can be recommended in PPG to reduce postoperative gallstone formation [ 56 ]. The benefit of preserving the celiac branch of the vagus nerve is controversial, and reports on its effectiveness are two-sided [ 54 , 57 ].…”

A new technique for treating hiatal hernia with gastroesophageal reflux disease: the laparoscopic total left-side surgical approach

“…Studies have established that the hepatic branch of the vagus nerve regulates the movement of the liver and biliary tract [ 13 , 14 ]. When the nerve is damaged, it leads to decreased gallbladder peristalsis, limited bile secretion, and gastrointestinal hormone secretion imbalance, which increases the incidence of gallstones and necrotizing cholecystitis [ 15 , 16 ]. In severe cases, surgical intervention is required.…”

Prophylactic cholecystectomy: A valuable treatment strategy for cholecystolithiasis after gastric cancer surgery

“…A prospective case–control study by Wang et al. ( 42 ) compared the vagus nerve-sparing group (h-DG, n=85) and the dissected nerve group (s-DG, n=238) under laparoscopic distal gastrectomy and the vagus nerve preserving group (h-PPG, n=123) and dissected nerve group (s-PPG, n=21) under laparoscopic pylori-preserving gastrectomy. The results showed that the 3-year cumulative incidence of CL in the h-DG group was significantly lower than that in the s-DG group (2.7% vs. 14.6%, P=0.017).…”

“…vs. 12.9%, P=0.004). It suggested that both vagal-nerve-sparing gastrectomy and PPG can significantly reduce the incidence of CL development after gastric cancer surgery ( 38 , 42 ). However, recent studies have suggested that PPG has no effect on the development of CL ( 10 , 13 , 26 ).…”