Top

Langenbeck's Archives of Surgery

Published in:

01-02-2017 | ORIGINAL ARTICLE

Preserving infrapyloric vein reduces postoperative gastric stasis after laparoscopic pylorus-preserving gastrectomy

Authors: Takashi Kiyokawa, Naoki Hiki, Souya Nunobe, Michitaka Honda, Manabu Ohashi, Takeshi Sano

Published in: Langenbeck's Archives of Surgery | Issue 1/2017

Abstract

Purpose

Laparoscopic pylorus-preserving gastrectomy (LPPG) is performed to preserve function in treating early gastric cancer. However, gastric stasis is a potential complication of LPPG that could decrease postoperative quality of life, possibly due to gastric edema of the pyloric cuff caused by venous stasis. We introduced an infrapyloric vein (IPV)-preserving LPPG (iLPPG) procedure to prevent pyloric cuff edema and thus minimize the incidence of gastric stasis and investigated the early clinical outcomes of iLPPG.

Methods

We reviewed 150 patients with gastric cancer who underwent LPPG between August 2011 and June 2013 at the Cancer Institute Hospital and analyzed postoperative complications, incidence of gastric stasis (requiring starvation longer than 72 h or an invasive treatment), and transient delayed gastric emptying (TDGE).

Results

Of the 150 patients, 56 underwent iLPPG and 94 underwent conventional LPPG without preservation of the IPV (cLPPG). Morbidity rates were 5.4% in the iLPPG group and 23.4% in the cLPPG group (P = 0.003). The incidence of both gastric stasis and TDGE was significantly lower in the iLPPG group than in the cLPPG group (0 vs. 8.5%, P = 0.03 and 0 vs. 7.4%, P = 0.046, respectively). Median postoperative stay was significantly shorter in the iLPPG group compared to the cLPPG group (9 vs. 11 days, P < 0.001, respectively).

Conclusions

Preservation of the IPV might prevent the incidence of postoperative gastric stasis after LPPG, resulting in a shorter postoperative stay.

Available only for authorised users

Maki T, Shiratori T, Hatafuku T, Sugawara K (1967) Pylorus-preserving gastrectomy as an improved operation for gastric ulcer. Surgery 61(6):838–845PubMed

Miwa K, Kinami S, Sato T, Fujimura T, Miyazaki I (1996) Vagus-saving D2 procedure for early gastric carcinoma(in Japanese with English abstract). Nihon Geka Gakkai Zasshi 97(4):286–290PubMed

Ninomiya M, Ikeda T, Asakura H, Moriyama Y, Onoda T, Shiozaki A, Ohno S, Higaki K, Kobayashi N, Okamura S (1997) The clinical significance of gastrectomy with preservation of autonomic nerves and the pylorus accompanied with D2 dissection for early gastric cancer (in Japanese with English abstract). Jpn J Gastroenterol Surg 30(12):2239–2246CrossRef

do Park J, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK (2008) Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg 32(6):1029–1036. doi:10.1007/s00268-007-9441-4 CrossRefPubMed

Tomita R, Fujisaki S, Tanjoh K (2003) Pathophysiological studies on the relationship between postgastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancer. World J Surg 27(6):725–733. doi:10.1007/s00268-003-6906-y CrossRefPubMed

Nunobe S, Sasako M, Saka M, Fukagawa T, Katai H, Sano T (2007) Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer : Off J Int Gastric Cancer Assoc Japanese Gastric Cancer Assoc 10(3):167–172. doi:10.1007/s10120-007-0434-7 CrossRef

Nunobe S, Hiki N, Fukunaga T, Tokunaga M, Ohyama S, Seto Y, Yamaguchi T (2007) Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis. World J Surg 31(12):2335–2340. doi:10.1007/s00268-007-9262-5 CrossRefPubMed

Tanaka N, Katai H, Saka M, Morita S, Fukagawa T (2011) Laparoscopy-assisted pylorus-preserving gastrectomy: a matched case-control study. Surg Endosc 25(1):114–118. doi:10.1007/s00464-010-1142-7 CrossRefPubMed

Hiki N, Sano T, Fukunaga T, Ohyama S, Tokunaga M, Yamaguchi T (2009) Survival benefit of pylorus-preserving gastrectomy in early gastric cancer. J Am Coll Surg 209(3):297–301. doi:10.1016/j.jamcollsurg.2009.05.027 CrossRefPubMed

10.

Jiang X, Hiki N, Nunobe S, Fukunaga T, Kumagai K, Nohara K, Katayama H, Ohyama S, Sano T, Yamaguchi T (2011) Long-term outcome and survival with laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Surg Endosc 25(4):1182–1186. doi:10.1007/s00464-010-1336-z CrossRefPubMed

11.

Jiang X, Hiki N, Nunobe S, Fukunaga T, Kumagai K, Nohara K, Sano T, Yamaguchi T (2011) Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Ann Surg 253(5):928–933. doi:10.1097/SLA.0b013e3182117b24 CrossRefPubMed

12.

Hiki N, Kaminishi M (2005) Pylorus-preserving gastrectomy in gastric cancer surgery--open and laparoscopic approaches. Langenbeck’s archives of surgery / Deutsche Gesellschaft fur Chirurgie 390(5):442–447. doi:10.1007/s00423-005-0573-4 CrossRef

13.

Hiki N, Shimoyama S, Yamaguchi H, Kubota K, Kaminishi M (2006) Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation. J Am Coll Surg 203(2):162–169. doi:10.1016/j.jamcollsurg.2006.05.003 CrossRefPubMed

14.

Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer : Off J Int Gastric Cancer Assoc Japan Gastric Cancer Assoc 14(2):101–112. doi:10.1007/s10120-011-0041-5 CrossRef

15.

Sawai K, Takahashi T, Fujioka T, Minato H, Taniguchi H, Yamaguchi T (1995) Pylorus-preserving gastrectomy with radical lymph node dissection based on anatomical variations of the infrapyloric artery. Am J Surg 170(3):285–288CrossRefPubMed

16.

Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195(2):284–287CrossRefPubMed

17.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

18.

Michels NA (1955) Blood supply and anatomy of the upper abdominal organs, with a descriptive atlas. Lippincott

19.

Kuroda C, Nakamura H, Sato T, Yoshioka H, Tokunaga K, Hori S, Okamura J, Uchida H, Ishida O (1982) Normal anatomy of the pyloric branch and its diagnostic significance in angiography. Acta Radiol: Diagn 23(5):479–484CrossRef

20.

Haruta S, Shinohara H, Ueno M, Udagawa H, Sakai Y, Uyama I (2015) Anatomical considerations of the infrapyloric artery and its associated lymph nodes during laparoscopic gastric cancer surgery. Gastric Cancer : Off J Int Gastric Cancer Assoc Japan Gastric Cancer Assoc 18(4):876–880. doi:10.1007/s10120-014-0424-5 CrossRef

21.

Petrén T (1929) Die Arterien und Venen des Duodenums und des Pankreaskopfes beim Menschen. Zeitschrift für Anatomie und Entwicklungsgeschichte 90(2):234–277. doi:10.1007/bf02117893 CrossRef

22.

Hollinshead WH (1971) The thorax, abdomen, and pelvis, vol v. 2. Anatomy for surgeons, 2nd edn. Harper & Row, New York

23.

Nakajima T, Yamaguchi T (2006) Gastric cancer database of Japanese Cancer Institute Hospital 1946–2004. Kanehara & CO. LTD., Tokyo

Title: Preserving infrapyloric vein reduces postoperative gastric stasis after laparoscopic pylorus-preserving gastrectomy
Authors: Takashi Kiyokawa
Naoki Hiki
Souya Nunobe
Michitaka Honda
Manabu Ohashi
Takeshi Sano
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 1/2017
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1529-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Preserving infrapyloric vein reduces postoperative gastric stasis after laparoscopic pylorus-preserving gastrectomy

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

Radiological findings and radiation exposure during trauma workup in a cohort of 1124 level 1 trauma patients

Operating lists are created by rational algorithms and use of power. What can a social scientific view offer surgeons?

Procalcitonin-guided antibiotic treatment in critically ill patients

Endoscopic mini/less open sublay technique (EMILOS)—a new technique for ventral hernia repair

Sinusoidal obstruction syndrome in the animal model: influence on liver surgery

Stage-directed therapy of pleural empyema