Abstract
Background
Thoracic and foregut operations can cause vagal nerve injury resulting in delayed gastric emptying or gastroparesis. However, the cause of gastroparesis in these patients is not always from a vagal injury. We hypothesize that vagal nerve integrity (VNI) testing may better define who has vagal nerve dysfunction. This information may change subsequent operations. The aim of this study was to evaluate the impact of VNI testing in patients with prior thoracic or gastric surgery.
Methods
From January 2014 to December 2017, patients who had previous operations with the potential risk of vagal injury and had VNI testing were reviewed. Excluded patients were those with no plan for a second operation or the second operation was only for gastroparesis. The main outcome was the percentage of operations altered due to the results of VNI testing.
Results
Twelve patients (eight females) were included. Ages ranged from 37 to 77 years. VNI results were compatible with vagal injury in eight patients (67%). VNI test results altered subsequent operative plans in 41.7% (5/12). Pyloroplasty was done in addition to fundoplication in two patients. Plans for hiatal hernia repair with or without redo-fundoplication in three patients were changed by an additional pyloroplasty in one patient and partial gastrectomy with Roux-en-Y reconstruction in two patients. All patients who had secondary surgery had resolution of symptoms and improvement in objective testing.
Conclusion
The addition of VNI testing in patients with a previous potential risk of vagal nerve injury may help the surgeon select the appropriate secondary operation.
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References
Fich A, Neri M, Camilleri M et al (1990) Stasis syndromes following gastric surgery: clinical and motility features of 60 symptomatic patients. J Clin Gastroenterol 12(5):505–512
Berkowitz N, Schulman LL, McGregor C et al (1995) Gastroparesis after lung transplantation. Potential role in postoperative respiratory complications. Chest 108(6):1602–1607
Salameh JR, Schmieg RE Jr, Runnels JM et al (2007) Refractory gastroparesis after Roux-en-Y gastric bypass: surgical treatment with implantable pacemaker. J Gastrointest Surg 11(12):1669–1672
Camilleri M, Parkman HP, Shafi MA et al (2013) Clinical guideline: management of gastroparesis. Am J Gastroenterol 108(1):18–37 (quiz 38)
Bielefeldt K (2012) Gastroparesis: concepts, controversies, and challenges. Scientifica (Cairo) 2012:424802
Hasler WL (2008) Gastroparesis–current concepts and considerations. Medscape J Med 10(1):16
van Rijn S, Roebroek YG, Conchillo JM et al (2016) Effect of vagus nerve injury on the outcome of antireflux surgery: an extensive literature review. Dig Surg 33(3):230–239
van Rijn S, Rinsma NF, van Herwaarden-Lindeboom MY et al (2016) Effect of vagus nerve integrity on short and long-term efficacy of antireflux surgery. Am J Gastroenterol 111(4):508–515
Rebecchi F, Allaix ME, Giaccone C et al (2013) Gastric emptying as a prognostic factor for long-term results of total laparoscopic fundoplication for weakly acidic or mixed reflux. Ann Surg 258(5):831–836; (discussion 836–837)
Balaji NS, Crookes PF, Banki F et al (2002) A safe and noninvasive test for vagal integrity revisited. Arch Surg 137(8):954–958 (discussion 958–959)
Abell TL, Camilleri M, Donohoe K et al (2008) Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol 103(3):753–763
Lovgren NA, Poulsen J, Schwartz TW (1981) Impaired pancreatic innervation after selective gastric vagotomy. Reduction of the pancreatic polypeptide response to food and insulin hypoglycemia. Scand J Gastroenterol 16(6):811–816
DeVault KR, Swain JM, Wentling GK et al (2004) Evaluation of vagus nerve function before and after antireflux surgery. J Gastrointest Surg 8(7):883–888 (discussion 888–889)
Sodhi SS, Guo JP, Maurer AH et al (2002) Gastroparesis after combined heart and lung transplantation. J Clin Gastroenterol 34(1):34–39
Grass F, Schafer M, Cristaudi A et al (2015) Incidence and risk factors of abdominal complications after lung transplantation. World J Surg 39(9):2274–2281
Costa HF, Malvezzi Messias P, dos Reis FP et al (2017) Abdominal complications after lung transplantation in a Brazilian single center. Transplant Proc 49(4):878–881
Mertens V, Dupont L, Sifrim D (2010) Relevance of GERD in lung transplant patients. Curr Gastroenterol Rep 12(3):160–166
Raviv Y, D’Ovidio F, Pierre A et al (2012) Prevalence of gastroparesis before and after lung transplantation and its association with lung allograft outcomes. Clin Transplant 26(1):133–142
Gourcerol G, Benanni Y, Boueyre E et al (2013) Influence of gastric emptying on gastro-esophageal reflux: a combined pH-impedance study. Neurogastroenterol Motil 25(10):634–800
Emerenziani S, Sifrim D (2005) Gastroesophageal reflux and gastric emptying, revisited. Curr Gastroenterol Rep 7(3):190–195
Verne GN, Sninsky CA (1998) Diabetes and the gastrointestinal tract. Gastroenterol Clin N Am 27(4):861–874
Kong MF, Horowitz M (2005) Diabetic gastroparesis. Diabet Med 22(Suppl 4):13–18
Jones MP (2004) Management of diabetic gastroparesis. Nutr Clin Pract 19(2):145–153
Arts J, Holvoet L, Caenepeel P et al (2007) Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther 26(9):1251–1258
Friedenberg FK, Palit A, Parkman HP et al (2008) Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol 103(2):416–423
Bai Y, Xu MJ, Yang X et al (2010) A systematic review on intrapyloric botulinum toxin injection for gastroparesis. Digestion 81(1):27–34
Chu H, Lin Z, Zhong L et al (2012) Treatment of high-frequency gastric electrical stimulation for gastroparesis. J Gastroenterol Hepatol 27(6):1017–1026
Levinthal DJ, Bielefeldt K (2017) Systematic review and meta-analysis: gastric electrical stimulation for gastroparesis. Auton Neurosci 202:45–55
Alexander F, Wyllie R, Jirousek K et al (1997) Delayed gastric emptying affects outcome of Nissen fundoplication in neurologically impaired children. Surgery 122(4):690–697 (discussion 697–698)
Khajanchee YS, Dunst CM, Swanstrom LL (2009) Outcomes of Nissen fundoplication in patients with gastroesophageal reflux disease and delayed gastric emptying. Arch Surg 144(9):823–828
Masqusi S, Velanovich V (2007) Pyloroplasty with fundoplication in the treatment of combined gastroesophageal reflux disease and bloating. World J Surg 31(2):332–336
Jones MP, Maganti K (2003) A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol 98(10):2122–2129
Forstner-Barthell AW, Murr MM, Nitecki S et al (1999) Near-total completion gastrectomy for severe postvagotomy gastric stasis: analysis of early and long-term results in 62 patients. J Gastrointest Surg 3(1):15–21, (discussion 21–13)
Grover BT, Kothari SN (2015) Reoperative antireflux surgery. Surg Clin N Am 95(3):629–640
Acknowledgements
The authors would like to thank all staff personnel of Loyola University Medical Center, Maywood, IL, U.S.A. who helped with the data retrieval and provided the essential information. We would also like to thank Mr. Glenn Shingledecker in the Office of International Affairs, Faculty of Medicine, Prince of Songkla University for the proofreading and language support.
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Kamthorn Yolsuriyanwong, Eric Marcotte, Mukund Venu and Bipan Chand have no conflicts of interest or financial ties to disclose.
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Yolsuriyanwong, K., Marcotte, E., Venu, M. et al. Impact of vagus nerve integrity testing on surgical management in patients with previous operations with potential risk of vagal injury. Surg Endosc 33, 2620–2628 (2019). https://doi.org/10.1007/s00464-018-6562-9
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DOI: https://doi.org/10.1007/s00464-018-6562-9