Langenbeck's Archives of Surgery

, Volume 402, Issue 1, pp 49–56 | Cite as

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

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



Laparoscopic pylorus-preserving gastrectomy (LPPG) is performed to preserve function in treating early gastric cancer. However, gastric stasis is a potential complication of LPPG that could decrease postoperative quality of life, possibly due to gastric edema of the pyloric cuff caused by venous stasis. We introduced an infrapyloric vein (IPV)-preserving LPPG (iLPPG) procedure to prevent pyloric cuff edema and thus minimize the incidence of gastric stasis and investigated the early clinical outcomes of iLPPG.


We reviewed 150 patients with gastric cancer who underwent LPPG between August 2011 and June 2013 at the Cancer Institute Hospital and analyzed postoperative complications, incidence of gastric stasis (requiring starvation longer than 72 h or an invasive treatment), and transient delayed gastric emptying (TDGE).


Of the 150 patients, 56 underwent iLPPG and 94 underwent conventional LPPG without preservation of the IPV (cLPPG). Morbidity rates were 5.4% in the iLPPG group and 23.4% in the cLPPG group (P = 0.003). The incidence of both gastric stasis and TDGE was significantly lower in the iLPPG group than in the cLPPG group (0 vs. 8.5%, P = 0.03 and 0 vs. 7.4%, P = 0.046, respectively). Median postoperative stay was significantly shorter in the iLPPG group compared to the cLPPG group (9 vs. 11 days, P < 0.001, respectively).


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


Laparoscopic pylorus-preserving gastrectomy Infrapyloric vein Gastric stasis Gastric cancer 


Compliance with ethical standards

Authors’ contributions

  • Study conception and design: Takashi Kiyokawa, Naoki Hiki, and Souya Nunobe.

  • Acquisition of data: Takashi Kiyokawa, Michitaka Honda, and Manabu Ohashi.

  • Analysis and interpretation of data: Takashi Kiyokawa, Michitaka Honda, and Naoki Hiki.

  • Drafting of manuscript: Takashi Kiyokawa, Naoki Hiki, and Takeshi Sano.

  • Critical revision of manuscript: Naoki Hiki and Takeshi Sano.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

423_2016_1529_MOESM1_ESM.mp4 (353.8 mb)
ESM 1 (MP4 362,320 kb)
423_2016_1529_MOESM2_ESM.mp4 (337.1 mb)
ESM 2 (MP4 345,212 kb)


  1. 1.
    Maki T, Shiratori T, Hatafuku T, Sugawara K (1967) Pylorus-preserving gastrectomy as an improved operation for gastric ulcer. Surgery 61(6):838–845PubMedGoogle Scholar
  2. 2.
    Miwa K, Kinami S, Sato T, Fujimura T, Miyazaki I (1996) Vagus-saving D2 procedure for early gastric carcinoma(in Japanese with English abstract). Nihon Geka Gakkai Zasshi 97(4):286–290PubMedGoogle Scholar
  3. 3.
    Ninomiya M, Ikeda T, Asakura H, Moriyama Y, Onoda T, Shiozaki A, Ohno S, Higaki K, Kobayashi N, Okamura S (1997) The clinical significance of gastrectomy with preservation of autonomic nerves and the pylorus accompanied with D2 dissection for early gastric cancer (in Japanese with English abstract). Jpn J Gastroenterol Surg 30(12):2239–2246CrossRefGoogle Scholar
  4. 4.
    do Park J, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK (2008) Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg 32(6):1029–1036. doi: 10.1007/s00268-007-9441-4 CrossRefPubMedGoogle Scholar
  5. 5.
    Tomita R, Fujisaki S, Tanjoh K (2003) Pathophysiological studies on the relationship between postgastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancer. World J Surg 27(6):725–733. doi: 10.1007/s00268-003-6906-y CrossRefPubMedGoogle Scholar
  6. 6.
    Nunobe S, Sasako M, Saka M, Fukagawa T, Katai H, Sano T (2007) Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer : Off J Int Gastric Cancer Assoc Japanese Gastric Cancer Assoc 10(3):167–172. doi: 10.1007/s10120-007-0434-7 CrossRefGoogle Scholar
  7. 7.
    Nunobe S, Hiki N, Fukunaga T, Tokunaga M, Ohyama S, Seto Y, Yamaguchi T (2007) Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis. World J Surg 31(12):2335–2340. doi: 10.1007/s00268-007-9262-5 CrossRefPubMedGoogle Scholar
  8. 8.
    Tanaka N, Katai H, Saka M, Morita S, Fukagawa T (2011) Laparoscopy-assisted pylorus-preserving gastrectomy: a matched case-control study. Surg Endosc 25(1):114–118. doi: 10.1007/s00464-010-1142-7 CrossRefPubMedGoogle Scholar
  9. 9.
    Hiki N, Sano T, Fukunaga T, Ohyama S, Tokunaga M, Yamaguchi T (2009) Survival benefit of pylorus-preserving gastrectomy in early gastric cancer. J Am Coll Surg 209(3):297–301. doi: 10.1016/j.jamcollsurg.2009.05.027 CrossRefPubMedGoogle Scholar
  10. 10.
    Jiang X, Hiki N, Nunobe S, Fukunaga T, Kumagai K, Nohara K, Katayama H, Ohyama S, Sano T, Yamaguchi T (2011) Long-term outcome and survival with laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Surg Endosc 25(4):1182–1186. doi: 10.1007/s00464-010-1336-z CrossRefPubMedGoogle Scholar
  11. 11.
    Jiang X, Hiki N, Nunobe S, Fukunaga T, Kumagai K, Nohara K, Sano T, Yamaguchi T (2011) Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Ann Surg 253(5):928–933. doi: 10.1097/SLA.0b013e3182117b24 CrossRefPubMedGoogle Scholar
  12. 12.
    Hiki N, Kaminishi M (2005) Pylorus-preserving gastrectomy in gastric cancer surgery--open and laparoscopic approaches. Langenbeck’s archives of surgery / Deutsche Gesellschaft fur Chirurgie 390(5):442–447. doi: 10.1007/s00423-005-0573-4 CrossRefGoogle Scholar
  13. 13.
    Hiki N, Shimoyama S, Yamaguchi H, Kubota K, Kaminishi M (2006) Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation. J Am Coll Surg 203(2):162–169. doi: 10.1016/j.jamcollsurg.2006.05.003 CrossRefPubMedGoogle Scholar
  14. 14.
    Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer : Off J Int Gastric Cancer Assoc Japan Gastric Cancer Assoc 14(2):101–112. doi: 10.1007/s10120-011-0041-5 CrossRefGoogle Scholar
  15. 15.
    Sawai K, Takahashi T, Fujioka T, Minato H, Taniguchi H, Yamaguchi T (1995) Pylorus-preserving gastrectomy with radical lymph node dissection based on anatomical variations of the infrapyloric artery. Am J Surg 170(3):285–288CrossRefPubMedGoogle Scholar
  16. 16.
    Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195(2):284–287CrossRefPubMedGoogle Scholar
  17. 17.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Michels NA (1955) Blood supply and anatomy of the upper abdominal organs, with a descriptive atlas. LippincottGoogle Scholar
  19. 19.
    Kuroda C, Nakamura H, Sato T, Yoshioka H, Tokunaga K, Hori S, Okamura J, Uchida H, Ishida O (1982) Normal anatomy of the pyloric branch and its diagnostic significance in angiography. Acta Radiol: Diagn 23(5):479–484CrossRefGoogle Scholar
  20. 20.
    Haruta S, Shinohara H, Ueno M, Udagawa H, Sakai Y, Uyama I (2015) Anatomical considerations of the infrapyloric artery and its associated lymph nodes during laparoscopic gastric cancer surgery. Gastric Cancer : Off J Int Gastric Cancer Assoc Japan Gastric Cancer Assoc 18(4):876–880. doi: 10.1007/s10120-014-0424-5 CrossRefGoogle Scholar
  21. 21.
    Petrén T (1929) Die Arterien und Venen des Duodenums und des Pankreaskopfes beim Menschen. Zeitschrift für Anatomie und Entwicklungsgeschichte 90(2):234–277. doi: 10.1007/bf02117893 CrossRefGoogle Scholar
  22. 22.
    Hollinshead WH (1971) The thorax, abdomen, and pelvis, vol v. 2. Anatomy for surgeons, 2nd edn. Harper & Row, New YorkGoogle Scholar
  23. 23.
    Nakajima T, Yamaguchi T (2006) Gastric cancer database of Japanese Cancer Institute Hospital 1946–2004. Kanehara & CO. LTD., TokyoGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Takashi Kiyokawa
    • 1
  • Naoki Hiki
    • 1
  • Souya Nunobe
    • 1
  • Michitaka Honda
    • 1
  • Manabu Ohashi
    • 1
  • Takeshi Sano
    • 1
  1. 1.Department of Gastroenterological Surgery, Gastroenterological CenterCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan

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