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Clinical Efficacy of the Preservation of the Hepatic Branch of the Vagus Nerve on Delayed Gastric Emptying After Laparoscopic Pancreaticoduodenectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Delayed gastric emptying (DGE) is a common complication following laparoscopic pancreaticoduodenectomy (LPD), although it remains incompletely understood, and only few studies have investigated the clinical benefits of hepatic branch of the vagus nerve (HBVN) preservation on DGE after LPD until now. We intended to evaluate the effect of preservation of the HBVN during LPD on the incidence of DGE.

Methods

A total of 274 consecutive LPDs performed at a single center between July 2014 and December 2019 with available videos were retrospectively reviewed. DGE was defined according to the International Study Group of Pancreatic Surgery (ISGPS) criteria, and HBVN condition during the LPD procedure was evaluated through a video review. Risk factors associated with DGE were assessed by performing univariate and multivariate logistic regression analyses. Postoperative outcomes between the HBVN-preserved and HBVN-injury groups were compared before and after propensity score matching (PSM).

Results

One hundred fifty-six (56.93%) patients underwent LPD with HBVN-preserved and 118 (43.07%) with HBVN injury. DGE occurred in 33.2% of patients (n = 91) with grades B and C occurring at 13.9% (n = 38) and 7.7% (n = 21), respectively. Longer operative time, more EIBL, HBVN injury, POPF (grades B and C), postoperative hemorrhage, intra-abdominal infection, and Clavien-Dindo ≥III were identified as risk factors for DGE in the univariate analysis. Then, in the multivariate analysis, HBVN injury and intra-abdominal infection were found to be independent risk factors affecting the incidence of DGE (any grade) or clinically relevant DGE (grades B and C). Furthermore, the prevalence of DGE was significantly higher in the HBVN-injury group than in the HBVN-preserved group before and after PSM analysis (46.61% vs. 23.08%, P<0.001; 42.59% vs. 23.15%, P=0.013).

Conclusions

HBVN preservation during LPD might be associated with a reduced incidence of DGE as a framework for prospective quality improvement.

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Acknowledgements

We would like to thank Editage (www.editage.com) for the English language editing. We also would like to thank all the patients for participating in this study. In addition, we would like to express our gratitude to all healthcare providers who contributed for their cooperation and support.

Funding

This study was supported by grants from the National Natural Science Foundation of China (81772950, 81502633, and 81773160), the Hubei Natural Science Foundation (2017CFB467), and the Tongji Hospital Science Fund for Distinguished Young Scholars (2016YQ08).

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Author notes

  1. Xu Li, Tingting Qin, Feng Zhu and Min Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, Hubei, China

    Xu Li, Tingting Qin, Feng Zhu, Min Wang, Chao Dang, Li He, Shutao Pan, Yuhui Liu, Taoyuan Yin, Yecheng Feng, Xin Wang, Yahong Yu, Ming Shen, Xingpei Lu, Yongjun Chen, Li Jiang, Chenjian Shi & Renyi Qin

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  1. Xu Li
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Correspondence to Renyi Qin.

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Supplementary Information

ESM 1

Supplemental Digital Content 1.wmv Intraoperative injury of the HBVN. Case 1 and 2: Dissection of the lesser omentum with injury of the HBVN. (WMV 10740 kb)

ESM 2

(WMV 14793 kb)

ESM 3

Supplemental Digital Content 2.wmv Intraoperative preservation of the HBVN. Case 1 and 2: Dissection of the lesser omentum with preservation of the HBVN. (WMV 24109 kb)

ESM 4

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Li, X., Qin, T., Zhu, F. et al. Clinical Efficacy of the Preservation of the Hepatic Branch of the Vagus Nerve on Delayed Gastric Emptying After Laparoscopic Pancreaticoduodenectomy. J Gastrointest Surg 25, 2172–2183 (2021). https://doi.org/10.1007/s11605-021-05024-y

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