title: Efficacy of celiac branch preservation in Roux-en-y reconstruction after laparoscopy-assisted distal gastrectomy.
abstract: BACKGROUND
  The present study investigated the efficacy of preserving the celiac branch of the vagus nerve after laparoscopy-assisted distal gastrectomy (LADG) with Roux-en-Y (R-Y) reconstruction.
  
  
  METHODS
  Between January 2004 and September 2008, a total of 159 consecutive patients who underwent LADG for gastric carcinoma were classified into groups according to preservation of the celiac branch of the vagus nerve-preservation group (P-LADG; n = 70) and the resection group (R-LADG; n = 89). The parameters analyzed included patient and tumor characteristics, operative details, postoperative outcomes, and nutritional state. The endoscopic findings of the gastric remnant and lower esophagus were evaluated at 12 months postoperatively.
  
  
  RESULTS
  In regard to postoperative complications, no significant differences were found between groups. With R-LADG, 14 patients suffered from dumping syndrome (15.7%), compared with only 2 patients with P-LADG (2.9%; P = .007). The amount of meal consumption compared with the preoperative value and the rate of weight reduction at 12 months postoperatively did not differ significantly between groups. Endoscopic findings showed significantly more residue with P-LADG (34.3%) than with R-LADG (16.9%; P = .011).
  
  
  CONCLUSIONS
  The celiac branch is useful in regulating gastrointestinal motility by maintaining postoperative physiologic function. Celiac branch preservation seems to represent a feasible and beneficial method for LADG.
authors.affiliation: Department of Esophagogastric Surgery, University Hospital of Medicine, Tokyo Medical and Dental University, Tokyo, Japan. h-yamada.srg2@tmd.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamada
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Kojima
authors.forename: Mikito
authors.initials: M
authors.lastname: Inokuchi
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Kawano
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D002447:Celiac Plexus; D015331:Cohort Studies; D004377:Dumping Syndrome / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005769:Gastrointestinal Motility / Q000502:physiology; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013270:Stomach / Q000294:innervation*; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014630:Vagus Nerve