Skip to main content

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



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.


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.


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.


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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

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.


  1. Alden B (1949) Vagotomy and the anatomic variations in the vagus nerve. Am J Surg 78:4–14

    Article  Google Scholar 

  2. Baccaro LM, Lucas CN, Zandomeni MR, Selvino MVA, Albanese E (2013) Anatomy of the anterior vagus nerve: an anatomic description and its application in surgery. Anat Physiol 3:1000121.

    Article  Google Scholar 

  3. Bosmans G, Appaltans I, Stakenborg N, Gomez-Pinilla PJ (2019) Vagus nerve stimulation dampens intestinal inflammation in a murine model of experimental food allergy. Allergy 74:1748–1759.

    CAS  Article  PubMed  Google Scholar 

  4. Cailotto C, Pedro J, Costes LM, Vliet J, Giovangiulio DM et al (2014) Neuro-anatomical evidence indicating indirect modulation of macrophages by vagal efferents in the intestine but not in the spleen. PLoS ONE 9:e87785.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. Csendes A, Laranch J, Godoy M (1978) Incidence of gallstones development after selective hepatic vagotomy acta chirurgica. Scandinavica 144:289–291

    CAS  Google Scholar 

  6. Engineer ND, Kimberley TJ, Prudente N, Dawson J, Tarver WB, Hays SA (2019) Targeted vagus nerve stimulation for rehabilitation after stroke. Front Neurosci 13:280.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kamthorn W, Eric M, Mukund V, Bipan C (2019) Impact of vagus nerve integrity testing on surgical management in patients with previous operations with potential risk of vagal injury. Surg Endosc.

    Article  Google Scholar 

  8. Koopman FA, Schuurman P, Vervoordeldonk MJ, Tak PP (2014) Vagus nerve stimulation: a new bioelectronics approach to treat rheumatoid arthritis? Best Pract Res Clin Rheumatol 28:625–635.

    CAS  Article  PubMed  Google Scholar 

  9. Mackay TW, Andrews P (1983) A comparative study of the vagal innervation of the stomach and the ferret. J Anat 136:449–481

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Mitchell GA (1940) Macroscopic study of the nerve supply of the stomach. J Anat 75:50–63

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Netter F (1997) Atlas of human anatomy, 2nd edn. Novartis, New Jersey

    Google Scholar 

  12. Ozdogan M, Kuvvetli A, Das K et al (2013) Effect of preserving the hepatic vagal nerve during laparoscopic nissen fundoplication on postoperative biliary functions. World J Surg 37:1060–1064.

    Article  PubMed  Google Scholar 

  13. Peeples L (2019) The rise of bioelectric medicine sparks interest among researchers, patients, and industry. PNAS 116:24379–24382.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. Rhaya LJ, Christopher G (2018) A review of the vagus nerve stimulation as a therapeutic inetervention. J Inflamm Res 11:203–213.

    Article  Google Scholar 

  15. Rijn S, Van N, Rinsma MYA, Van HLJ, Ringers HG, Gooszen PJJ, Van RA, Veenendaal JM, Conchillo ND, Bouvyet AAM (2016) Effect of vagus nerve integrity on short and long-term efficacy of antireflux surgery. Am J Gastroenterol 111:508–515.

    Article  PubMed  Google Scholar 

  16. Ruckley CV, Falcnor C, Small NS (1970) Selective vagotomy: a review of the anatomy and technique in 100 patients. Br J Surg Soc Ltd 57:245–248

    CAS  Article  Google Scholar 

  17. Seeras K, Qasawa R, Prakash S (2020) Truncal vagotomy. StatPearls Publishing, Treasure Island

    Google Scholar 

  18. Stakenborg N, Giovangiulio M, Boeckxstaens GE, Matteoli G (2013) The versatile role of the vagus nerve in the gastrointestinal tract. Eur Med J Gastroenterol 1:106–114

    Google Scholar 

  19. Williams NS, Bulstrode C, O’Connell R (2008) Bailey and Love’s short practice of surgery, 25th edn. Hodder Arnold, Hachette

    Book  Google Scholar 

  20. Xue N, Liang H, Yao H, Song XM, Li JG (2011) The role of spleen in vagus nerve stimulation for treatment against septic shock in rats. Chin Crit Care Med 23:263–266

    CAS  Google Scholar 

  21. Zhou L, Filiberti A, Humphrey MB, Fleming CD, Scherlag BJ, Po SS, Stavrakis S (2019) Low-level transcutaneous vagus nerve stimulation attenuates cardiac remodelling in a rat model of heart failure with preserved ejection fraction. Exp Physiol 104:28–38.

    CAS  Article  PubMed  Google Scholar 

  22. Zhou L, Lin J, Kui G, Zhang J, Yu Y (2014) Neuroprotective effects of vagus nerve stimulation on traumatic brain injury. Neural Regener Res.

    Article  Google Scholar 

Download references


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.


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].

Author information

Authors and Affiliations



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.

Ethics declarations

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


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