Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis.
BACKGROUND
Pylorus-preserving gastrectomy (PPG) prevents postprandial symptoms; however, delayed gastric retention due to aberrant pylorus function can occur during the early postoperative period. This study aimed to establish a stasis-less PPG procedure with preservation of the vagal nerve and blood flow to the pyloric cuff, and to apply the technique for laparoscopy-assisted PPG.


METHODS
Ninety patients with T1 gastric cancer located in the middle third of the stomach were enrolled in this study for surgery from January 2003 to March 2006, undergoing either laparoscopy-assisted PPG (LAPPG; 39 patients) or conventional PPG (CPPG; 51 patients). Operative and early postoperative outcomes were compared between the two groups.


RESULTS
Relatively low rates of gastric stasis were observed in both the LAPPG (8%) and CPPG (6%) groups. Estimated blood loss in LAPPG (65.4 +/- 12.3 ml) patients was significantly lower than in the CPPG group (160.7 +/- 19.6 ml) (p < 0.001), and the total number of dissected lymph nodes was significantly greater in the LAPPG group (36.2 +/- 1.8) than in the CPPG group (29.0 +/- 1.3) (p = 0.001).


CONCLUSIONS
A PPG procedure with less postoperative stasis and adequate lymph node retrieval was established and applied successfully in laparoscopy-assisted surgery.
Nunobe
Souya
S
Department of Surgery, Cancer Institute Hospital, Tokyo, Japan. sonunobe@cick.jp
Hiki
Naoki
N
Fukunaga
Tetsu
T
Tokunaga
Masanori
M
Ohyama
Shigekazu
S
Seto
Yasuyuki
Y
Yamaguchi
Toshiharu
T
D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods*; D018589:Gastroparesis / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011178:Postgastrectomy Syndromes / Q000517:prevention & control; D011708:Pylorus / Q000098:blood supply / Q000503:physiopathology; D013274:Stomach Neoplasms / Q000601:surgery; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology