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Vagus nerve-preserving versus conventional laparoscopic splenectomy and azygoportal disconnection

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Abstract

Background

Conventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to the vagal nerve. We have developed vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection (VLSD). This study aimed to evaluate whether VLSD is effective and safe, and to determine whether a reduction in the incidence of postoperative complications improves postoperative quality of life compared with CLSD.

Methods

We retrospectively evaluated outcomes in 72 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism who underwent CLSD (n = 40) or VLSD (n = 32) between April 2015 and December 2016. Their demographic, intraoperative, and postoperative variables were compared.

Results

No patients required conversion to laparotomy in CLSD and VLSD. There was no difference in estimated intraoperative blood loss, volume of intraoperative blood transfused, time to first flatus, time to off-bed activity, and postoperative hospital stay between the two groups. VLSD was associated with a shorter operation time (P = 0.020) and less postoperative complications (P < 0.0001), including less diarrhea (P < 0.0001), epigastric fullness (P < 0.0001), and delayed gastric emptying (P < 0.0001), compared with CLSD. With VLSD, there was a significant increase in body weight and plasma albumin levels at 6 months postoperatively compared with preoperative values (all P < 0.05). The curative effect of improving esophageal/gastric variceal bleeding was similar in the groups.

Conclusions

VLSD is effective and safe for reducing the incidence of postoperative complications, contributing to improving postoperative quality of life.

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Acknowledgements

This work was supported by the Scientific Research Subject of Jiangsu Province Health Department (No. H201661) and the Project of Invigorating Health Care through Science, Technology and Education: Jiangsu Provincial Medical Youth Talent (QNRC2016331).

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Author notes

  1. Dou-Sheng Bai, Ping Chen, and Sheng-Jie Jin have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Rd, Yangzhou, 225000, China

    Dou-Sheng Bai, Ping Chen, Sheng-Jie Jin, Jian-Jun Qian & Guo-Qing Jiang

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  1. Dou-Sheng Bai
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  2. Ping Chen
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  3. Sheng-Jie Jin
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  4. Jian-Jun Qian
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Corresponding author

Correspondence to Guo-Qing Jiang.

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Disclosure

Drs. Dou-Sheng Bai, Ping Chen, Sheng-Jie Jin, Jian-Jun Qian, and Guo-Qing Jiang have no conflicts of interest or financial ties to disclose.

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Bai, DS., Chen, P., Jin, SJ. et al. Vagus nerve-preserving versus conventional laparoscopic splenectomy and azygoportal disconnection. Surg Endosc 32, 2696–2703 (2018). https://doi.org/10.1007/s00464-017-5965-3

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  • DOI: https://doi.org/10.1007/s00464-017-5965-3

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