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Anatomical variation and distribution of the vagus nerve in the esophageal hiatus: a cross-sectional study of post-mortem cases in Uganda

Abstract

Purpose

Vagus nerve injuries during gastroesophageal surgery may cause significant symptoms due to loss of vagal anti-inflammatory and neuromodulator function. Many previous studies have shown high anatomical variability of the vagus nerve at the esophageal hiatus, but information on its variability in Uganda specifically and Africa in general is scanty. This study provides a reliable and detailed description of the anatomical variation and distribution of the vagus nerve in the esophageal hiatus region of post-mortem cases in Uganda.

Methods

This was an analytical cross-sectional survey of 67 unclaimed post-mortem cases. Data collection used a pretested data collection form. Data were entered into Epi-Info version 6.0 data base then exported into STATA software 13.0 for analysis.

Results

The pattern of the anterior vagal trunk structures at the esophageal hiatus was: single trunk [65.7%]; biplexus [20.9%]; triplexus [8.9%] and double-but-not-connected trunks [4.5%]. The pattern of the posterior trunk structures were: single trunk [85.1%]; biplexus 10.4% and triplexus [4.5%]. There was no statistically significant gender difference in the pattern of vagal fibres. There was no major differences in the pattern from comparable British studies.

Conclusion

The study confirmed high variability in the distribution of the vagus nerve at the esophageal hiatus, unrelated to gender differences. Surgeons must consider and identify variants of vagal innervation when carrying out surgery at the gastroesophageal junction to avoid accidental vagal injuries. Published surgical techniques for preserving vagal function are valid in Uganda.

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Availability of data and materials

The full dataset generated and analyzed during the current study are not publicly available for ethical reasons. However, deidentified data can be made available from the corresponding author on reasonable request.

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Acknowledgements

We wish to thank Prof. Celestino Obua for research skills mentorship, and for securing the funding we used from the Makerere-Sweden Research Cooperation (SIDA). We also thank Dr Atwine Daniel who contributed invaluable insight in proposal development and data analysis. We also acknowledge the Director of Health services, Uganda Police, Dr Moses Byaruhanga and Dr. Samuel Kalungi, a senior pathologist, whose contribution in data collection made this research possible.

Funding

The work was supported by Makerere-Sweden Research Cooperation (Makerere University SIDA-program) as part of the project titled Makerere-SIDA PHASE IV 2015/2020 under Grant Agreement No. [DRGT 377].

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Authors and Affiliations

Authors

Contributions

RK: Project development, data collection or management, data analysis, manuscript writing/editing. GN: project development, data collection or management, manuscript writing/editing. MK: manuscript writing/editing. GM: project development, data collection, manuscript writing/editing. IOA: data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Kamoga Ronald.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Consent to participate

Informed consent was waived because researchers only accessed unclaimed bodies that had no identified living relative(s) or legal representatives. Administrative permission was received from the Uganda police authorities, the custodians of all unclaimed bodies, before data collection.

Ethical approval

Approval of this study was obtained from the Research Ethics Committee of Mbarara University of Science and Technology (Ref.No. MUREC1/7) and the Uganda National Council for Science and Technology (Ref. No. HS2223). The procedures used in this study adhered to the tenets of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Ronald, K., Gladys, N., Mugagga, K. et al. Anatomical variation and distribution of the vagus nerve in the esophageal hiatus: a cross-sectional study of post-mortem cases in Uganda . Surg Radiol Anat 43, 1243–1248 (2021). https://doi.org/10.1007/s00276-020-02642-0

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  • DOI: https://doi.org/10.1007/s00276-020-02642-0

Keywords

  • Vagus nerve
  • Uganda
  • Distribution
  • Variation
  • Esophageal hiatus