Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis

World J Surg. 2007 Dec;31(12):2335-40. doi: 10.1007/s00268-007-9262-5.

Abstract

Background: Pylorus-preserving gastrectomy (PPG) prevents postprandial symptoms; however, delayed gastric retention due to aberrant pylorus function can occur during the early postoperative period. This study aimed to establish a stasis-less PPG procedure with preservation of the vagal nerve and blood flow to the pyloric cuff, and to apply the technique for laparoscopy-assisted PPG.

Methods: Ninety patients with T1 gastric cancer located in the middle third of the stomach were enrolled in this study for surgery from January 2003 to March 2006, undergoing either laparoscopy-assisted PPG (LAPPG; 39 patients) or conventional PPG (CPPG; 51 patients). Operative and early postoperative outcomes were compared between the two groups.

Results: Relatively low rates of gastric stasis were observed in both the LAPPG (8%) and CPPG (6%) groups. Estimated blood loss in LAPPG (65.4 +/- 12.3 ml) patients was significantly lower than in the CPPG group (160.7 +/- 19.6 ml) (p < 0.001), and the total number of dissected lymph nodes was significantly greater in the LAPPG group (36.2 +/- 1.8) than in the CPPG group (29.0 +/- 1.3) (p = 0.001).

Conclusions: A PPG procedure with less postoperative stasis and adequate lymph node retrieval was established and applied successfully in laparoscopy-assisted surgery.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Female
  • Gastrectomy / adverse effects*
  • Gastrectomy / methods*
  • Gastroparesis / physiopathology
  • Gastroparesis / prevention & control*
  • Humans
  • Laparoscopy*
  • Lymph Node Excision
  • Male
  • Middle Aged
  • Postgastrectomy Syndromes / prevention & control
  • Pylorus / blood supply
  • Pylorus / physiopathology
  • Stomach Neoplasms / surgery
  • Treatment Outcome
  • Vagus Nerve / physiopathology