Preserving infrapyloric vein reduces postoperative gastric stasis after laparoscopic pylorus-preserving gastrectomy

Kiyokawa, Takashi; Hiki, Naoki; Nunobe, Souya; Honda, Michitaka; Ohashi, Manabu; Sano, Takeshi

doi:10.1007/s00423-016-1529-6

Cited by 30 publications

(28 citation statements)

References 18 publications

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“…This procedure has been routinely performed by most surgeons. Kiyokawa published another report concluding that preservation of infrapyloric vein would further reduce the incidence of gastric stasis [27]. To our knowledge, this present study reports the lowest prevalence of delayed gastric emptying following PPG.…”

Section: Discussionsupporting

confidence: 45%

Clinical outcomes of intraoperative manual dilatation of pylorus in pylorus-preserving gastrectomy: a retrospective analysis

et al. 2018

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Section: Discussionsupporting

confidence: 45%

Clinical outcomes of intraoperative manual dilatation of pylorus in pylorus-preserving gastrectomy: a retrospective analysis

et al. 2018

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“…Patients who underwent PPG sometimes report the feeling of gastric fullness, and some patients exhibit long-term retention of food in the residual stomach; however, some investigators claim that the vagal nerve and the infrapyloric artery should be preserved to prevent postoperative stasis, which is experienced by 6% to 8% of the patients (7,11). Specifically related to the rate of gastric stasis after LAPPG, the infrapyloric vein should prevent pyloric cuff edema, thus minimizing the incidence of gastric stasis; a study indeed investigated early clinical outcomes of LAPPG with preservation of the infrapyloric vein, not only infrapyloric artery (28). The incidence of both gastric stasis and transient delayed gastric emptying was significantly lower in patients who underwent LAPPG that preserved the infrapyloric artery and vein than in those who underwent LAPPG without the preservation of the infrapyloric vein.…”

Section: Gastric Stasis After Ppgmentioning

confidence: 99%

Function-preserving surgery for gastric cancer: current status and future perspectives

Nunobe

Hiki

2017

Transl. Gastroenterol. Hepatol.

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The number of early gastric cancer (EGC) cases has been increasing because of improved diagnostic procedures including endoscopy and screening systems. Therefore, function-preserving gastrectomy (FPG) for EGC with the expectation of better quality of life (QOL) after surgery may be increasingly utilized, due to its association with low rate of lymph node metastasis and excellent survival and the possibility of employing less invasive procedures such as laparoscopic gastrectomy in combination. Pylorus-preserving gastrectomy (PPG) with curative intent lymph node dissection is a representative FPG that has been used in EGC, and its superiorities, indications, limitations, and survival benefits have already been reported in several retrospective studies. Laparoscopic proximal gastrectomy (LAPG) has also been employed in EGC of the upper third of the stomach; however, LAPG was found to be associated with major issues in achieving a balance between swallowing and reflux prevention. In patients with EGC in the upper third of the stomach, laparoscopy-assisted subtotal gastrectomy with a preserved, albeit very small, stomach may provide a better QOL and fewer postoperative complications. FPG is recommended as a surgical treatment for EGC if the indication is accurately diagnosed and strictly confirmed; however, these techniques in laparoscopic surgery present technical difficulties to surgeons without a certain degree of skills. Although many retrospective studies revealed the functional benefits or oncological safety with FPG, further prospective studies using large case series are necessary to reveal the value of FPG compared with the conventional procedures.

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“…Moreover, it is well-known that the vagal nerves such as PHCV are an important factor in intestinal peristalsis [20]. In addition, it is reported that preservations of the infrapyloric artery and vein are important to prevent the postoperative gastric stasis after PPG [15] [16]. Ischemia around pylorus may lead to pyloric dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…PGD such as malnutrition due to loss of appetite, weight loss, EDS, RE, or GRS are unfavorable sequelae in patients after conventional It is considered that PGD, especially PAF with GSRS, after PPG is due to damage to PHCV and infrapyloric vesscels (artery and vein) as a result of skeletonization of the subpyloric region with the subpyloric lymph node dissection [15] [16]. It is also reported that PHCV are necessary for pyloric sphincter functioning in patients after PPG [11] [12].…”

Section: Discussionmentioning

confidence: 99%

Relationships between Length of the Antral Cuff and Postgastrectomy Disorders and Gastric Empting Function in Patients after Pylorus-Preserving Gastrectomy for Early Gastric Cancer

Tomita¹,

Sakurai²,

Fujisaki³

2017

JCT

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Objectives: To clarify the optimal length of the antral cuff (LAC) in patients after pylorus-preserving gastrectomy (PPG), we investigated relationships between LAC and postgastrectomy disorder (PGD) such as postprandial abdominal fullness (PAF), and between LAC and gastric empting function (GEF) in PPG patients. Background: The main cause of PGD in PPG patients has been considered to be LAC. Relationships between LAC and PGD and GEF in PPG patients are still unknown. Methods: Of 50 patients who underwent PPG in our hospital from January 2001 to December 2015 were divided into 2 groups [Group A, short LAC of 1.5 to 2.5 cm (n = 24); Group B, long LAC of 2.6 to 3.5 cm (n = 26)]. The relationships among LAC, PGD, and GEF were retrospectively studied. Results: LAC was clearly shorter in group A than group B (P < 0.01). PAF, appetite and food consumption per meal were clearly more favorable in group B than in group A (P < 0.01, respectively). Symptomatic reflux esophagitis (RE), early dumping syndrome, decreased percent body weight for pre-illness, endoscopic RE and endoscopic gastritis in the remnant stomach were more frequent in group A than group B. Gastric stasis in the remnant stomach was clearly more frequent in group A than group B (P < 0.01). GEF with the solid diet in group A was clearly more delayed than in group B (P < 0.01). Conclusions: Patients with a short LAC showed worse postoperative QOL and delayed GEF with the solid diet compared with a long LAC.

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Preserving infrapyloric vein reduces postoperative gastric stasis after laparoscopic pylorus-preserving gastrectomy

Abstract: Preservation of the IPV might prevent the incidence of postoperative gastric stasis after LPPG, resulting in a shorter postoperative stay.

Cited by 30 publications

References 18 publications

Clinical outcomes of intraoperative manual dilatation of pylorus in pylorus-preserving gastrectomy: a retrospective analysis

Clinical outcomes of intraoperative manual dilatation of pylorus in pylorus-preserving gastrectomy: a retrospective analysis

Function-preserving surgery for gastric cancer: current status and future perspectives

Relationships between Length of the Antral Cuff and Postgastrectomy Disorders and Gastric Empting Function in Patients after Pylorus-Preserving Gastrectomy for Early Gastric Cancer

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