Surgical Endoscopy

, Volume 22, Issue 9, pp 2003–2008 | Cite as

Functional evaluation after vagus nerve–sparing laparoscopically assisted distal gastrectomy

  • Kazuyuki Kojima
  • Hiroyuki Yamada
  • Mikito Inokuchi
  • Tatuyuki Kawano
  • Kenichi Sugihara



Vagus nerve–sparing laparoscopically assisted distal gastrectomy (Vs-LADG) for early gastric cancer has been introduced to reduce postgastrectomy syndrome, but its clinical and functional outcomes remain unclear.


Of the 105 patients reviewed in this study, 75 underwent Vs-LADG and 30 underwent laparoscopically assisted distal gastrectomy (LADG) for gastric cancer between January 1999 and May 2006. The clinical and functional outcomes of these two groups were compared.


The clinical and pathologic background between the two groups did not differ. The incidence of gallstone was significantly lower in the Vs-LADG group than in the LADG group (p < 0.05), but no differences existed in duration of surgery, intraoperative blood loss, number of retrieved lymph nodes, time to first flatus after surgery, or length of hospital stay between the two groups.


As shown by the findings, Vs-LADG is a safe and minimally invasive surgery that may decrease the incidence of gallstone formation after gastrectomy.


Early gastric cancer Functional evaluation Laparoscopic surgery Nerve sparing Vagus nerve 


  1. 1.
    Matsukuma A, Furusawa M, Tomoda H, Seo Y (1996) A clinicopathological study of asymptomatic gastric cancer. Br J Cancer 74:1647–1650PubMedGoogle Scholar
  2. 2.
    Adachi Y, Mori M, Maehara Y, Kitano S, Sugimachi K (1997) Prognostic factors of node-negative gastric carcinoma: univariate and multivariate analyses. J Am Coll Surg 184:373–377PubMedGoogle Scholar
  3. 3.
    Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H (1996) Surgical treatment for gastric cancer: the Japanese approach. Semin Oncol 23:360–368PubMedGoogle Scholar
  4. 4.
    Siewert JR, Sendler A (1999) The current management of gastric cancer. Adv Surg 33:69–93PubMedGoogle Scholar
  5. 5.
    Makuuchi H, Kise Y, Shimada H, Chino O, Tanaka H (1999) Endoscopic mucosal resection for early gastric cancer. Semin Surg Oncol 17:108–116PubMedCrossRefGoogle Scholar
  6. 6.
    Ono H (2005) Endoscopic submucosal dissection for early gastric cancer. Chin J Dig Dis 6:119–121PubMedCrossRefGoogle Scholar
  7. 7.
    Ohgami M, Otani Y, Kumai K, Kubota T, Kim YI, Kitajima M (1999) Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 23:187–193PubMedCrossRefGoogle Scholar
  8. 8.
    Adachi Y, Suematsu T, Shiraishi N, Katsuta T, Morimoto A, Kitano S (1999) Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg 229:49–54PubMedCrossRefGoogle Scholar
  9. 9.
    Kodama M, Koyama K (1991) Indications for pylorus-preserving gastrectomy for early gastric cancer located in the middle third of the stomach. World J Surg 15:628–634PubMedCrossRefGoogle Scholar
  10. 10.
    Zhang D, Shimoyama S, Kaminishi M (1998) Feasibility of pylorus-preserving gastrectomy with a wider scope of lymph adenectomy. Arch Surg 133:993–997PubMedCrossRefGoogle Scholar
  11. 11.
    Miwa K, Kinami S, Sato T, Fujimura T, Miyazaki I (1996) Vagus-saving D2 procedure for early gastric carcinoma (in Japanese). Nippon Geka Gakkai Zasshi (J Jpn Surg Soc) 97:286–290Google Scholar
  12. 12.
    Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMedGoogle Scholar
  13. 13.
    Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S (2000) Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 135:806–810PubMedCrossRefGoogle Scholar
  14. 14.
    Mochiki E, Nakabayashi T, Kamimura H, Haga N, Asao T, Kuwano H (2002) Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer. World J Surg 26:1145–1149PubMedCrossRefGoogle Scholar
  15. 15.
    Asao T, Kuwano H, Mochiki E (2004) Laparoscopic surgery update for gastrointestinal malignancy. J Gastroenterol 39:309–318PubMedCrossRefGoogle Scholar
  16. 16.
    Kojima K, Yamashita T, Inokuchi M, Sugihara K (2002) Technique of vagus nerve–sparing laparoscopy-assisted distal gastrectomy. Dig Endosc 14:103–106CrossRefGoogle Scholar
  17. 17.
    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English edn. Gastric Cancer 1:10–24PubMedCrossRefGoogle Scholar
  18. 18.
    Kennedy T, Connell AM, Love AH, MacRae KD, Spencer EF (1973) Selective or truncal vagotomy? Five-year results of a double-blind, randomized controlled trial. Br J Surg 60:944–948PubMedCrossRefGoogle Scholar
  19. 19.
    Mujahed Z, Evans JA (1971) The relationship of cholelithiasis to vagotomy. Surg Gynecol Obstet 133:656–658PubMedGoogle Scholar
  20. 20.
    Ihasz M, Griffith CA (1981) Gallstones after vagotomy. Am J Surg 141:48–50PubMedCrossRefGoogle Scholar
  21. 21.
    Kinami S, Miwa K, Sato T, Miyazaki I (1997) Section of the vagal celiac branch in man reduces glucagon-stimulated insulin release. J Auton Nerv Syst 64:44–48PubMedCrossRefGoogle Scholar
  22. 22.
    Isozaki H, Okajima K, Momura E, Ichinona T, Fujii K, Izumi N Takeda Y (1996) Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 83:266–269PubMedCrossRefGoogle Scholar
  23. 23.
    Shinohara H, Sonoda T, Niki M, Nomura E, Nishiguchi K, Tanigawa N (2002) Laparoscopically assisted pylorus-preserving gastrectomy with preservation of the vagus nerve. Eur J Surg 168:55–58PubMedCrossRefGoogle Scholar
  24. 24.
    Uyama I, Sakurai Y, Komori Y, Nakamura Y, Syoji M, Tonomura S, Yohida I, Masui T, Ochiai M (2005) Laparoscopic gastrectomy with preservation of the vagus nerve accompanied by lymph node dissection for early gastric carcinoma. J Am Coll Surg 200:140–145PubMedCrossRefGoogle Scholar
  25. 25.
    Sakuramoto S, Kikuchi S, Kuroyama S, Futawatari N, Katada N, Kobayashi N, Watanabe M (2006) Laparoscopy-assisted distal gastrectomy for early gastric cancer: experience with 111 consecutive patients. Surg Endosc 20:55–60PubMedCrossRefGoogle Scholar
  26. 26.
    Tsuji H, Andoh S, Sakakibara K (2003) The clinical evaluation of vagus nerve–preserving gastric operation with D2 lymph node dissection for early and advanced gastric cancer (in Japanese). Jpn J Gastroenterol Surg 36:78–87Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Kazuyuki Kojima
    • 1
  • Hiroyuki Yamada
    • 1
  • Mikito Inokuchi
    • 1
  • Tatuyuki Kawano
    • 1
  • Kenichi Sugihara
    • 2
  1. 1.Department of Esophagogastric SurgeryTokyo Medical and Dental University Graduate School of MedicineBunkyo-kuJapan
  2. 2.Department of Surgical OncologyTokyo Medical and Dental University Graduate School of MedicineBunkyo-kuJapan

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