Medical Therapies to Conquer Surgical Diseases: Gallstone Disease May Be the Next Frontier.
International journal of general medicine
Over the past half century, diseases that were predominantly treated surgically have transitioned to less invasive medical therapies. Such diseases that are now effectively treated with medicine are (1) peptic ulcer disease (PUD), (2) coronary artery disease (CAD), and (3) gastrointestinal stromal tumors (GISTs). Likewise, gallstone disease may soon follow this trend. Currently, the gold standard treatment of symptomatic gallstones is laparoscopic cholecystectomies. Though one of the most common surgeries in the United States, certain cases of acute and gangrenous cholecystitis can be some of the most difficult surgeries to perform. Advancements in neutrophil extracellular trap (NET) inhibitor medical therapies will alter gallstone disease management and the mainstream role of surgical interventions. This focus on less invasive therapies will greatly impact the quality of patient care, financial obligations, and even resident training opportunities.
10.2147/IJGM.S434877
Effectiveness of preserved vagal nerve in totally laparoscopy radical distal gastrectomy: a matched-paired cohort analysis.
Surgical endoscopy
BACKGROUND:The aim of this retrospective matched-paired cohort study was to clarify the effectiveness of preserving the vagus nerve in totally laparoscopic radical distal gastrectomy (TLDG). METHODS:One hundred eighty-three patients with gastric cancer who underwent TLDG between February 2020 and March 2022 were included and followed up. Sixty-one patients with preservation of the vagal nerve (VPG) in the same period were matched (1:2) to conventional sacrificed (CG) cases for demographics, tumor characteristics, and tumor node metastasis stage. The evaluated variables included intraoperative and postoperative indices, symptoms, nutritional status, and gallstone formation at 1 year after gastrectomy between the two groups. RESULTS:Although the operation time was significantly increased in the VPG compared with the CG (198.0 ± 35.2 vs. 176.2 ± 35.2 min, P < 0.001), the mean time of gas passage in the VPG was significantly lower than that in the CG (68.1 ± 21.7 h vs. 75.4 ± 22.6 h, P = 0.038). The overall postoperative complication rate was similar between the two groups (P = 0.794). There was no statistically significant difference between the two groups hospital stay, total number of harvested lymph nodes, and mean number of examined lymph nodes at each station. During follow-up, the morbidity of gallstones or cholecystitis (8.2% vs. 20.5%, P = 0.036), chronic diarrhea (3.3% vs. 14.8%, P = 0.022), and constipation (4.9% vs. 16.4%, P = 0.032) were significantly lower in the VPG than in the CG in this study. Moreover, injury to the vagus nerve was found to be an independent risk factor for gallstone formation or cholecystitis and chronic diarrhea in univariate analysis and multivariate analysis. CONCLUSION:The vagus nerve plays an imperative role in gastrointestinal motility, and hepatic and celiac branch preservation mainly exerts efficacy and safety in patients who undergo TLDG.
10.1007/s00464-023-10254-z
Gallbladder sludge and stone formation in relation to contractile function after gastrectomy. A prospective study.
Inoue K,Fuchigami A,Higashide S,Sumi S,Kogire M,Suzuki T,Tobe T
Annals of surgery
In a prospective trial to determine whether gastric surgery induces gallbladder sludge and stone formation, 48 patients with gastric cancer were ultrasonographically examined with simultaneous observation on changes in gallbladder contractile function before and serially for 5 years after gastrectomy. Gallbladder sludge formation was induced with a high frequency of 42% 1 month after gastrectomy, with corresponding significant lowering of gallbladder contractile function. Most of gallbladder sludges, however, disappeared within 12 months in relation to the gradual recovery of gallbladder contractile function. Conversely, gallstone developed in nine patients (18.8%), mostly more than 6 months after gastrectomy. Interestingly, gallstone formation was induced in seven patients who were sludge negative. An evolvement of gallbladder sludge into stone was observed in only two patients, who were, however, treated with intravenous hyperalimentation. This study first provides evidence for the relationship between gastrectomy and a considerably high frequency of incidence of gallbladder sludge and stone in relation to changes in gallbladder kinetics after gastrectomy.
10.1097/00000658-199201000-00002
XbaI polymorphisms of apolipoprotein B gene: another risk factor of gallstone formation after radical gastrectomy.
Liu Feng-Lin,Lu Wen-Bin,Niu Wei-Xin
World journal of gastroenterology
AIM:To prospectively investigate the association between the XbaI polymorphisms of apolipoprotein B (APOB) gene and gallstone formation following gastrectomy. METHODS:The study was conducted between January 2005 and December 2006. A total of 186 gastric cancer patients who had undergone radical gastrectomy were grouped according to XbaI polymorphisms of APOB gene (X(+)X(-) group, n = 24 and X(-)X(-) group, n = 162) and compared. The XbaI polymorphisms of APOB gene were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS:The incidence of gallstone was significantly higher in the X(+)X(-) group than in the X(-)X(-) group [54.2% vs 9.3%, RR = 5.85 (2.23-15.32), P < 0.001]. The serum levels of total cholesterol (TC) and low-density lipoprotein (LDL) were higher in the X(+)X(-) than in the X(-)X(-) group (4.02 +/- 1.12 vs 3.48 +/- 0.88, P = 0.004 before surgery and 3.88 +/- 1.09 vs 3.40 +/- 0.86, P = 0.008 after surgery). LDL was 2.21 +/- 0.96 vs 1.89 +/- 0.84 (P = 0.042) before surgery and 2.09 +/- 0.95 vs 1.72 +/- 0.85 (P = 0.029) after surgery in the two groups. No relationship was found between XbaI polymorphisms and gallbladder motility. CONCLUSION:In Chinese patients after radical gastrectomy, X(+) allele of APOB gene is another risk factor for the development of gallstone besides the gallbladder motility disorder after surgery.
10.3748/wjg.v16.i20.2549
[Post-gastrectomy gallstone disease].
Ise H,Kitayama O,Hayasaka H,Matsuno S
Nihon rinsho. Japanese journal of clinical medicine
Biliary tree of gastrectomized patients was examined with ultrasonography to investigate the factors affecting post-gastrectomy gallstone formation. Only gallbladder stone was found in 57 (18.9%). In 11 (20.0%) of 55 patients, stones had developed within 2 years after surgery, but no difference in incidence were observed by sex and age. Sixty four gastrectomized gallstone patients were examined in respect to the kind of gallstone. Patients with cholesterol gallstones were 18 (28.1%), patients with black gallstones were 29 (45.3%) and patients with calcium bilirubinate gallstones were 17 (26.6%). The incidence rate of cholesterol gallstones was lower and the rate of black gallstones and calcium bilirubinate gallstones was higher than that of non-gastrectomized patients. In conclusion, the incidence of pigment gallstones is very high in gastrectomized patients.
Risk Factors for Gallstone Formation in Resected Gastric Cancer Patients.
Paik Kyu-Hyun,Lee Jong-Chan,Kim Hyoung Woo,Kang Jingu,Lee Yoon Suk,Hwang Jin-Hyeok,Ahn Sang Hoon,Park Do Joong,Kim Hyung-Ho,Kim Jaihwan
Medicine
Previous studies reported increased incidence of gallstone formation after gastrectomy. However, there were few reports about factors other than surgical technique. The purpose of this study is to investigate the spectrum of risk factors of gallstone formation after gastrectomy. From June 2003 to December 2008, 1480 patients who underwent gastrectomy due to gastric cancer but had no gallstones before surgery were identified. Electronic medical records were retrospectively reviewed. Gallstones were assessed by computerized tomography or ultrasound performed as surveillance for recurrence. There were 987 men (66.7%) and the median age was 59.0 years. The median follow-up period was 47.0 months. According to the surgical technique, 754 (50.9%), 459 (31.1%), and 267 (18.0%) underwent subtotal gastrectomy with Billroth I (STG B-I) and Billroth II (STG B-II) anastomosis, and total gastrectomy (TG). Within the follow-up period, gallstone formation occurred in 106 of 1480 patients (7.2%), the only 9 patients (0.6%) experienced symptomatic cholecystitis. By multivariate Cox regression analysis, age (HR 1.02, 95% CI 1.00-1.04), male (1.65, 1.02-2.67), diabetes mellitus (2.15, 1.43-3.24), ≥4% decrease of body mass index after surgery (1.66, 1.02-2.70), STG B-II (1.63, 1.03-2.57), and TG (2.35, 1.43-3.24) compared with STG B-I were associated with gallstone formation. Common bile duct stone formation occurred in 20 of 1480 patients (1.4%) and was only associated with gallstones. After gastrectomy, there were considerable numbers of patients with newly developed gallstones; however, prophylactic cholecystectomy should not be routinely recommended. Gastrectomy (STG B-II or TG), old age, male sex, diabetes mellitus, and decreased body mass index were associated with gallstones.
10.1097/MD.0000000000003157
Increased risk of gallstones after gastrectomy: A longitudinal follow-up study using a national sample cohort in korea.
Medicine
This study sought to evaluate the association between gastrectomy and the occurrence of gallstones using a national sample cohort from Korea.Data from 2002 to 2013 were collected for individuals ≥20 years of age in the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC). We extracted data for patients who had undergone gastrectomy (n = 1998) and a 1:4 matched control group (n = 7992) and then analyzed the occurrence of gallstones. The patients were matched according to age, sex, income, region of residence, hypertension, diabetes mellitus, and history of dyslipidemia. Gastrectomies were identified using operation codes (Q2533-Q2537, Q2594-Q2596, and Q2598). Gallstones were diagnosed if the corresponding International Classification of Disease-10 code (K80) was reported ≥2 times. Crude (simple) and adjusted hazard ratios (HRs) were analyzed using Cox proportional hazard models, and 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed based on age and sex.The adjusted HR for gallstones was 1.77 (95% CI = 1.34-2.35, P < .001) in the gastrectomy group compared to control. Consistent HRs were found in the analyses of all of the subgroups determined using age and sex.The occurrence of gallstones was increased in the patients who had undergone gastrectomy compared to their matched control group.
10.1097/MD.0000000000015932
Individualized Choice of Simultaneous Cholecystectomy in Patients with Gastric Cancer: A Systematic Review and Meta-analysis.
Annals of surgical oncology
BACKGROUND:Patients undergoing gastrectomy for gastric cancer are more likely to develop gallstones than the general population. Prophylactic cholecystectomy remains controversial. METHODS:Studies from 2000-2022 were systematically searched in the PubMed, EMBASE, and Cochrane Library databases. The search included simultaneous cholecystectomy or risk factors for gallstone formation with gastrectomy alone. Major prognostic factors included complications and mortality, and risk factor analyses included age, sex, TNM stage, gastrectomy type, lymph node dissection, diabetes, and duodenal exclusion. Random effects regression models were used to analyze risk estimates and data were presented as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). RESULTS:There were no significant differences in postoperative morbidity (OR 1.12, 95% CI 0.90-1.39; p = 0.33, I = 11%) and mortality (OR 1.23, 95% CI 0.62-2.43; p = 0.56, I = 0%) between gastrectomy alone and simultaneous cholecystectomy. Older age (OR 1.48, 95% CI 1.36-1.59; p < 0.001, I = 59%), male sex (OR 1.38, 95% CI 1.10-1.71; p = 0.004, I = 77%), total gastrectomy (OR 1.50, 95% CI 1.25-1.81; p < 0.001, I = 72%), diabetes mellitus (OR 1.38, 95% CI 1.17-1.63; p < 0.001, I = 8%), and duodenal exclusion (OR 1.77, 95% CI 1.47-2.15; p < 0.001, I = 30%) were risk factors for cholecystolithiasis. CONCLUSIONS:Simultaneous cholecystectomy did not increase the incidence of postoperative complications or mortality. Older age, male sex, total gastrectomy, duodenal exclusion, and diabetes were risk factors for gallstone development after gastrectomy.
10.1245/s10434-022-12792-7
Analysis of gallstone disease after gastric cancer surgery.
Liang Tsung-Jung,Liu Shiuh-Inn,Chen Yu-Chia,Chang Po-Min,Huang Wei-Chun,Chang Hong-Tai,Chen I-Shu
Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
BACKGROUND:The incidence rate of newly developed gallstone disease after gastrectomy for gastric cancer is thought to be higher than that in the general population. However, the presentation and management of these gallstones remain under debate, and the role of prophylactic cholecystectomy remains questionable. METHODS:Data on adult patients who were diagnosed with gastric cancer and received gastrectomy between 2000 and 2011 were extracted from the Taiwan National Health Insurance Research Database. A patient was excluded if he or she had gallstone disease or received cholecystectomy before the index date. The incidence of newly developed gallstone disease and its subsequent management were recorded. Data were analyzed to evaluate the factors associated with gallstone development and treatment options. RESULTS:A total of 17,325 gastric cancer patients who underwent gastrectomy were eligible for analysis. During the follow-up period (mean 4.1 years; median, 2.9 years), 1280 (7.4%) patients developed gallstone disease and 560 (3.2%) patients subsequently underwent cholecystectomy. The in-hospital mortality for cholecystectomy was 1.8% (10/560). Development of gallstone disease was associated with older age, total gastrectomy, duodenal exclusion, diabetes, cirrhosis, and more comorbidities. Factors associated with the use of cholecystectomy to treat gallstone disease included younger age, fewer comorbidities, medical center admission, and presentation as cholecystitis. CONCLUSIONS:Although few patients required further gallbladder removal after gastrectomy for gastric malignancy, the increased mortality rate for subsequent cholecystectomy was worth noting. The decision to undergo prophylactic cholecystectomy might be individualized based upon patient characteristics and the surgeon's discretion.
10.1007/s10120-017-0698-5
Gallstone formation after gastric cancer surgery.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
BACKGROUND:Gallstone formation is one of the most common complications after gastric cancer surgery, but the mechanism and etiology for such formation are unclear because of a lack of collective clinical investigation. METHOD:We evaluated the influence of various surgical factors on the incidence of gallstone formation after gastrectomy. Gallstone formation was confirmed by ultrasound examinations that were routinely carried out after surgery on a periodic basis. RESULTS:Gallstone formation occurred in 173 of 672 (25.7%) patients who had undergone gastrectomy with lymph-node dissection for gastric cancer. The types of gastrectomy and reconstruction had no significant effect on the incidence, but the extent of lymph-node dissection was a significant factor (p < 0.001: D1 + alpha vs. D2 + alpha; p < 0.01: D2 vs. D2 + alpha). Gallstones were usually formed within 2 years after gastrectomy, but in most cases, gallstone formation was asymptomatic. CONCLUSION:The extent of lymph-node dissection was a significant factor in gallstone formation after gastrectomy; therefore, prophylactic cholecystectomy should be considered in cases of extensive lymph-node dissection.
10.1007/s11605-009-0832-8
Increased gallstone formation after sleeve gastrectomy and the preventive role of ursodeoxycholic acid.
Acta gastro-enterologica Belgica
BACKGROUND AND STUDY AIMS:To investigate the incidence of gallstone formation, and the use of Ursodeoxycholic Acid (UDCA), weight loss and serum lipid profile changes following obesity surgery. PATIENTS AND METHODS:Patients who underwent bariatric surgery due to obesity were retrospectively reviewed and divided into 2 groups for their prophylactic UDCA use. Patients who had a previous gallbladder pathology and ones who did not have a preoperative ultrasonography (US) were excluded. The patients who have returned to our clinic for a control ultrasound between 6 and 18 months following the surgery were included in this study, but only if they did not have any gall bladder pathology demonstrated with an US prior to surgery. Body mass index (BMI) and lipid profile measurements were also recorded. RESULTS:Of the 108 patients who had undergone obesity surgery, it is reported that 42 (38.9%) were given UDCA as a preventative medication, and 66 (61.1%) were not prescribed any preventative medications. During the ultrasound controls in the postoperative period between 6 and 18 months after surgery, gallbladder stones were seen in 42 patients (38.9%) and biliary sludge development was detected in 5 patients (4.6%). A total of 47 patients (43.5%) developed gallbladder pathology. Fewer patients who took UDCA developed gallstones when compared with the patients who did not take UDCA (10% vs 33%). Also, there is a correlation between BMI loss rate and the frequency of gallstone development. Though the decrease in triglyceride (TG) levels was higher in patients with gallstone development, this decrease was not statistically significant. CONCLUSIONS:Stone or sludge development in the gallbladder due to rapid weight loss after obesity surgery is quite common. However, we observed that the gallstone development decreased significantly with the prophylactic use of UDCA in patients who had undergone obesity surgery.
Clinical analysis of prophylactic cholecystectomy during gastrectomy for gastric cancer patients: a retrospective study of 1753 patients.
Tan Zhenhua,Xie Ping,Qian Hai,Yao Xing
BMC surgery
BACKGROUND:Performance of gastrectomy in gastric cancer patients can lead to an increased incidence of cholecystolithiasis (CL) and a higher morbidity rate. However, the value of prophylactic cholecystectomy performed during gastric cancer surgery is still being debated. METHODS:We carried out a retrospective study on patients with gastric cancer who underwent subtotal or total gastrectomy, with preservation of the gallbladder or simultaneous cholecystectomy from January 2010 to March 2018. RESULTS:Cholecystolithiasis occurred in 152 of 1691 (8.98%) patients after gastric cancer surgery, with 45 (2.67%) patients undergoing subsequent cholecystectomy. Postoperative body mass index (BMI) decrease > 5% in 3 months was an independent risk factor for cholecystolithiasis [BMI decrease > 5%/≤5%: OR (95%CI): 1.812 (1.225-2.681), p = 0.003). Gastrectomy method and diabetes mellitus were independent risk factors for both cholecystolithiasis [gastrectomy method (no-Billroth I/Billroth I): OR (95%CI): 1.801 (1.097-2.959), p = 0.002; diabetes mellitus (yes/no): OR (95%CI): 1.544 (1.030-2.316), p = 0.036] and subsequent cholecystectomy [gastrectomy method (no-Billroth I/Billroth I): OR (95%CI): 5.432 (1.309-22.539), p = 0.020; diabetes mellitus (yes/no): OR (95%CI): 2.136 (1.106-4.125), p = 0.024]. Simultaneous cholecystectomy was performed in 62 of 1753 (3.5%) patients. The mortality and morbidity rates did not differ significantly between the combined surgery group and the gastrectomy only group (8.1% vs. 8.9 and 1.6% vs. 2.2%, respectively, p > 0.05). CONCLUSIONS:Prophylactic cholecystectomy may be necessary in gastric cancer patients without Billroth I gastrectomy and with diabetes mellitus. Simultaneous cholecystectomy during gastric cancer surgery does not increase the postoperative mortality and morbidity rates.
10.1186/s12893-019-0512-x
Analysis of risk factors for the development of gallstones after gastrectomy.
Kobayashi T,Hisanaga M,Kanehiro H,Yamada Y,Ko S,Nakajima Y
The British journal of surgery
BACKGROUND:The incidence of gallstones is higher in people who have undergone gastrectomy than in the general population, but the cause of this is unknown. METHODS:Between January 1992 and January 2003, 749 patients underwent ultrasonography of the gallbladder after gastrectomy for gastric cancer. A total of 2327 examinations were carried out. The incidence of gallstones was compared in subgroups of patients classified according to the type of reconstruction, extent of gastrectomy, whether the duodenum was excluded and type of lymph node dissection. RESULTS:The incidence of gallstones was significantly higher after total compared with partial gastrectomy (27.9 versus 7.8 per cent at 5 years; P < 0.001). Reconstruction with duodenal exclusion was associated with a significantly higher incidence than non-exclusion (25.1 versus 8.2 per cent at 5 years; P < 0.001). Patients who had lymph node dissection in the hepatoduodenal ligament had a significantly higher incidence of gallstones than those who did not (28.2 versus 7.5 per cent at 5 years; P < 0.001). In multivariate analysis that included type of reconstruction and lymph node dissection, lymph node dissection in the hepatoduodenal ligament was identified as the most significant risk factor for gallstone development (odds ratio 3.66 (95 per cent confidence interval 2.16 to 6.22); P < 0.001). CONCLUSION:Lymph node dissection in the hepatoduodenal ligament, total gastrectomy and exclusion of the duodenum are risk factors for gallstones after gastrectomy.
10.1002/bjs.5117
Laparoscopic Sleeve Gastrectomy for Morbid Obesity in 3003 Patients: Results at a High-Volume Bariatric Center.
Sakran Nasser,Raziel Asnat,Goitein Orly,Szold Amir,Goitein David
Obesity surgery
BACKGROUND:Laparoscopic sleeve gastrectomy (LSG) is gaining wide acceptance as a single surgical treatment for obesity. The reported morbidity and mortality rates are low. We herein report the results of LSG performed in a high-volume center by an experienced team. METHODS:Retrospective analysis of a prospectively maintained database of all bariatric surgery (BS) was performed between May 2006 and December 2014. Data inspected included operative time, length of hospital stay (LOS), comorbidity resolution, re-operation, percent excess weight loss (%EWL), and 30-day morbidity and mortality. RESULTS:In the study period, 3003 patients underwent BS (1901 (63 %) female). Mean age and body mass index (BMI) were 43 years (range 14-73) and 42.8 kg/m(2) (range 35-73), respectively. %EWL at 1 year was 72 % (n = 937; 57 % follow-up rate). There was 1 perioperative mortality due to bleeding (0.03 %). Comorbidity improvement and resolution were 98 % for obstructive sleep apnea, 79 % for diabetes mellitus, 87 % for dyslipidemia, and 85 % for hypertension. Mean operative time and LOS were 50 min (range 32-94) and 2.2 days (range 1-38), respectively. Of the patients, 132 had complications (4.4 %), 25 leaks (0.83 %), 63 bleeding (2.1 %), 1 intra-abdominal abscesses (0.03 %), 3 sleeve strictures (0.1 %), 2 mesenteric vein thromboses (0.06 %), 10 trocar site hernias (0.3 %), and 78 symptomatic cholelithiasis (2.6 %). Re-operation was needed in 13 patients (0.43 %). CONCLUSION:In a high-volume center with an experienced team, LSG can be performed with low morbidity and mortality.
10.1007/s11695-016-2063-x
The Cholegas trial: long-term results of prophylactic cholecystectomy during gastrectomy for cancer-a randomized-controlled trial.
Bencini Lapo,Marchet Alberto,Alfieri Sergio,Rosa Fausto,Verlato Giuseppe,Marrelli Daniele,Roviello Franco,Pacelli Fabio,Cristadoro Luigi,Taddei Antonio,Farsi Marco,
Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
BACKGROUND:The incidence of cholelithiasis has been shown to be higher for patients after gastrectomy than for the general population, due to vagal branch damage and gastrointestinal reconstruction. The aim of this trial was to evaluate the need for routine concomitant prophylactic cholecystectomy (PC) during gastrectomy for cancer. METHODS:A multicenter, randomized, controlled trial was conducted between November 2008 and March 2017. Of the total 130 included patients, 65 underwent PC and 65 underwent standard gastric surgery only for curable cancers. The primary endpoint was cholelithiasis-free survival after gastrectomy for gastric adenocarcinoma. Cholelithiasis was detected by ultrasound exam. RESULTS:After a median follow-up of 62 months, eight patients (12.3%) in the control group developed biliary abnormalities (four cases of gallbladder calculi and four cases of biliary sludge), with only three (4.6%) being clinically relevant (two cholecystectomies needed, one acute pancreatitis). One patient in the PC group had asymptomatic biliary dilatation during sonography after surgery. The cholelithiasis-free survival did not show statistical significance between the two groups (P = 0.267). The number needed to treat with PC to avoid reoperation for cholelithiasis was 1:32.5. CONCLUSIONS:Concomitant PC during gastric surgery for malignancies, although reducing the absolute number of biliary abnormalities, has no significant impact on the natural course of patients.
10.1007/s10120-018-0879-x
[Cholelithiasis after total gastrectomy for gastric cancer].
Lorusso D,Pezzolla F,Lantone G,Guerra V
Annali italiani di chirurgia
After gastric resection for peptic ulcer and total gastrectomy for Zollinger-Ellison syndrome, there is an increased prevalence of cholelithiasis. In order to assess whether this increased prevalence also exists after total gastrectomy for cancer, we evaluated the rate of cholelithiasis (echographic diagnosis) both before and after this operation. Between 1980 and 1990, 89 patients underwent total gastrectomy for cancer in the Surgical Department of our Institute. The pre-operative prevalence of gallstones was 5% in the males and 13.8% in the females. Seventy-four of the eighty-nine patients (83%) were examined post-operatively (7 patients with pre-operative cholelithiasis, 3 who died during the post-operative stay and 5 lost to follow-up were excluded from the study). The median post-operative follow-up was 24 months (range 3-115 months). The post-operative prevalence of cholelithiasis in the 74 patients was 39.6% in the males and 19% in the females. We also calculated the expected frequency of gallstones in both the pre- and post-operative groups from prevalence data in the population of the city where our Institute is based (taken from an echographic survey). We then compared the observed frequency of cholelithiasis with the expected frequency and we found that the difference in pre-operative frequencies, both in the males and females, was not statistically significant (p > 0.05). The same was true of the post-operative frequencies in the females (p = 0.48), but in the males there was a statistically significant difference between the observed frequency of cholelithiasis and that expected after total gastrectomy (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
[Cholelithiasis after total gastrectomy for gastric cancer].
Bianchi A,Suñol J,Casals S,Badía A,Ubach M
Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva
AIM:To examine the incidence of cholelithiasis in patients after total gastrectomy for gastric cancer. PATIENTS AND METHODS:Patients operated for gastric cancer at our hospital were retrospectively studied. Criteria to be included in the study were: 1) Follow-up of more than 3 years, 2) Cholelithiasis excluded preoperatively by ultrasonography, 3) Ultrasonographic postoperative control once a year. RESULTS:Ten patients met the established criteria. Six of them developed biliary lithiasis, and four of them needed surgical treatment for biliary symptomatology. CONCLUSIONS:The incidence of cholelithiasis after total gastrectomy for gastric cancer is high, and surgical treatment is often necessary. However our data does not support prophylactic cholecystectomy in the course of total gastrectomy.
Impaired gallbladder function in patients after total gastrectomy.
Tyrväinen Tuula,Nordback Isto,Toikka Jyri,Piiroinen Anneli,Herzig Karl-Heinz,Mäkelä Kari,Sand Juhani
Scandinavian journal of gastroenterology
BACKGROUND AND AIMS:The incidence of gallstones and gallbladder sludge is higher in patients after total gastrectomy than in general population. Formation of gallstones after gastrectomy is multifactorial. Here, we investigate the changes in gallbladder and biliary tract functions by cholescintygraphy and monitored changes in cholecystokinin (CCK) release in long-term survivors after total gastrectomy for gastric carcinoma. MATERIAL AND METHODS:Patients had undergone total gastrectomy for gastric carcinoma at least five years ago. The final study population consisted of 25 patients. RESULTS:Eight patients had undergone cholecystectomy before or at the time of gastrectomy. Gallstone formation was observed in seven of the remaining 17 patients during follow-up (41%). Maximum uptake of radioactivity and gallbladder maximum uptake was significantly delayed in the gastrectomy group than in the control group. There was no significant difference in CCK levels after the overnight fasting and at 60 minutes after stimulation among patients with or without stones in situ compared with healthy volunteers, but 30 minutes after the energy-rich drink patients had higher CCK levels than the control group. CONCLUSIONS:In gastrectomy patients, technetium isotope visualisation of the gallbladder and time for maximum activity was significantly delayed. This may indicate impaired gallbladder function. On the contrary, CCK release was not impaired.
10.1080/00365521.2016.1256422
Cholelithiasis: a serious complication after total gastrectomy.
Hauters P,de Neve de Roden A,Pourbaix A,Aupaix F,Coumans P,Therasse G
The British journal of surgery
To establish the incidence of cholelithiasis after total gastrectomy, patients operated on between 1979 and 1985 were reviewed. The study group consisted of 30 patients, all free of gallstones at the time of their gastrectomy. The median age of the patients was 56 years, the average follow-up 40 months. Cholelithiasis developed in 47 per cent of patients (14/30) and always within 2 years of total gastrectomy. The incidence of cholelithiasis was not related significantly to the sex or age of the patients. Morbidity from cholelithiasis was not negligible. Three of the fourteen patients presenting with gallstones required medical treatment in hospital and later came to cholecystectomy because of specific biliary symptoms. Cholelithiasis appears to be a significant complication after total gastrectomy. It may be related to the vagotomy which is performed at the time of gastrectomy.
10.1002/bjs.1800750923
Important risk factors for gallstones after laparoscopic gastrectomy: a retrospective study.
Fujita Shohei,Kimata Masaru,Matsumoto Kenji,Sasakura Yuichi,Terauchi Toshiaki,Furukawa Junji,Ogata Yoshiro,Kobayashi Kenji,Shinozaki Hiroharu
BMC surgery
BACKGROUND:The frequency of gallstones is higher in patients who have undergone gastrectomy than in the general population. While there have been some studies of gallstone formation after open gastrectomy, there are few reports of gallstones after laparoscopic gastrectomy (LG). Therefore, this study aimed to evaluate the incidence of gallstones after LG. METHODS:We retrospectively reviewed the records of 184 patients who underwent LG between January 2011 and May 2016 at Saiseikai Utsunomiya Hospital. After gastrectomy, abdominal ultrasonography was generally performed every 6 months for 5 years. Patients who underwent cholecystectomy before LG, underwent simultaneous cholecystectomy, and did not undergo abdominal ultrasonography, with an observation period of < 24 months, were excluded from the study. Finally, 90 patients were analyzed. Laparoscopic cholecystectomy was performed whenever biliary complications occurred. Patient characteristics were compared using the two-tailed Fisher's exact test or Chi-square test. In addition, the risk factors for postoperative gallstones were analyzed using logistic regression analysis. RESULTS:Among the 90 patients included in this study, 60 were men (78%), and the mean age was 65.5 years. Laparoscopic total gastrectomy was performed for 15 patients and laparoscopic distal gastrectomy for 75 patients. D2 lymph node dissection was performed for 8 patients (9%), whereas 68 patients underwent LG with Roux-en-Y reconstruction (76%). Gallstones were detected after LG in 27 of the 90 (30%) patients. Multivariate analysis identified Roux-en-Y reconstruction and male sex as significant risk factors of gallstones after gastrectomy. The incidence of gallstones was significantly higher (53%) in male patients who underwent Roux-en-Y reconstruction. Symptomatic gallstones after laparoscopic cholecystectomy were found in 6 cases (6/27, 22%), and all patients underwent laparoscopic cholecystectomy. CONCLUSION:Roux-en-Y reconstruction and male sex were identified as significant risk factors for gallstones after LG.
10.1186/s12893-021-01458-y
High incidence of gallstones after Roux-en-Y reconstruction gastrectomy in gastric cancer: a multicenter, long-term cohort study.
International journal of surgery (London, England)
BACKGROUND:Roux-en-Y reconstruction is a common anastomosis technique during gastrectomy in gastric cancer. There is a lack of studies on gallstones after Roux-en-Y reconstruction gastrectomy. This study investigated the incidence and potential risk factors associated with gallstones after Roux-en-Y reconstructive gastrectomy in gastric cancer. METHODS:The study analyzed data from gastric cancer who underwent radical gastrectomy and Roux-en-Y reconstruction at two hospitals between January 2014 and December 2020. The patients fall into distal and total gastrectomy groups based on the extent of gastrectomy. The cumulative event probability curve was plotted using the Kaplan-Meier, and differences in gallstone between groups were evaluated using the Log-Rank. Propensity score matching was applied to construct a balanced total versus distal gastrectomies cohort. A Cox regression was employed to analyze the risk factors for gallstones after Roux-en-Y reconstructive gastrectomy in gastric cancer. Further subgroup analysis was performed. RESULTS:Five hundred thirty-one patients were included in this study, 201 in the distal gastrectomy group and 330 in the total gastrectomy. During the follow-up, gallstones occurred in 170 cases after gastrectomy, of which 145 cases accounted for 85.29% of all stones in the first two years after surgery. Then, to reduce the impact of bias, a 1:1 propensity score matching analysis was performed on the two groups of patients. A total of 344 patients were evaluated, with each subgroup comprising 172 patients. In the matched population, the Cox regression analysis revealed that females, BMI ≥23 kg/m 2 , total gastrectomy, No.12 lymph node dissection, and adjuvant chemotherapy were risk factors for gallstones after Roux-en-Y reconstructive gastrectomy. Subgroup analysis showed that open surgery further increased the risk of gallstones after total gastrectomy. CONCLUSION:The incidence of gallstones increased significantly within 2years after Roux-en-Y reconstructive gastrectomy for gastric cancer. Patients with these risk factors should be followed closely after gastrectomy to avoid symptomatic gallstones.
10.1097/JS9.0000000000001136
The incidence of cholelithiasis after sleeve gastrectomy and its association with weight loss: A two-centre retrospective cohort study.
Manatsathit Wuttiporn,Leelasinjaroen Pornchai,Al-Hamid Hussein,Szpunar Susanna,Hawasli Abdelkader
International journal of surgery (London, England)
INTRODUCTION:Gallstones commonly develop after Roux-en-Y gastric bypass and other bariatric surgery; however, incidence of gallstone development after SG has not been adequately studied. METHODS:We conducted a retrospective cohort study of patients who underwent SG at two institutions from January 1, 2011 to December 31, 2012. Patients with previous cholecystectomy, preexisting gallstones, gallbladder polyps, or the absence of preoperative abdominal imaging were excluded. Follow-up abdominal ultrasonography was performed once the patients achieved 80-lb weight loss, became symptomatic, or reached one-year post-surgery. The incidence of gallstones and symptomatic gallstones and/or bile sludge was calculated. Different parameters of early and late postoperative weight loss were compared between the patients who developed gallstones and those who did not. RESULTS:During the study period, 253 underwent laparoscopic sleeve gastrectomy. Ultimately, 96 patients met inclusion criteria and were evaluated. The incidence of gallstone formation was 47.9% (46/96), and the incidence of symptomatic gallstones was 22.9% (22/96). None of the weight loss parameters during the early and late postoperative period were significantly different between the patients who developed gallstones and those who did not. CONCLUSION:Gallstones are a common complication after rapid weight loss from SG. Our data suggest that gallstone formation during the weight loss period is not associated with amount or rate of weight loss both during the early or late postoperative period.
10.1016/j.ijsu.2016.03.060
Higher incidence of cholelithiasis with Roux-en-Y reconstruction compared with Billroth-I after laparoscopic distal gastrectomy for gastric cancer: a retrospective cohort study.
Langenbeck's archives of surgery
PURPOSE:Cholelithiasis occurs often after gastrectomy. However, no consensus has been established regarding the difference in the incidence of postgastrectomy cholelithiasis with different reconstruction methods. In this study, we examined the frequency of cholelithiasis after two major reconstruction methods, namely Billroth-I (B-I) and Roux-en-Y (R-Y) following laparoscopic distal gastrectomy (LDG) for gastric cancer. METHODS:Among 696 gastric cancer patients who underwent LDG between April 2000 and March 2017, after applying the exclusion criteria, 284 patients who underwent B-I and 310 who underwent R-Y were examined retrospectively. The estimated incidence of cholelithiasis was compared between the methods, and factors associated with the development of cholelithiasis in the gallbladder and/or common bile duct were investigated. RESULTS:During the median follow-up of 61.2 months, 52 patients (8.8%) developed cholelithiasis postgastrectomy; 12 patients (4.2%) after B-I and 40 (12.9%) after R-Y (p = 0.0002). Among them, choledocholithiasis was more frequent in patients who underwent R-Y (n = 11, 27.5%) vs. B-I (n = 1, 8.3%) (p = 0.0056). Univariate and multivariate analyses revealed that male sex, body mass index > 22.5 kg/m, and R-Y reconstruction were significant predictors of the development of postLDG cholelithiasis. CONCLUSION:Regarding cholelithiasis development, B-I reconstruction should be preferred whenever possible during distal gastrectomy.
10.1007/s00423-024-03267-2
Study of cholelithiasis after gastrectomy.
Kinoshita H,Imayama H,Hashino K,Aoyagi S
The Kurume medical journal
We studied cholelithiasis that occurred after gastrectomy in 52 patients (35 males and 17 females) encountered at our department between January, 1978 and December, 1998. Gastrectomy had been performed for gastric or duodenal ulcer in 35, gastric cancer in 14, gastroptosis in 2, and gastric trauma in 1 of these patients. Reconstruction after gastrectomy was performed by the Billroth II method (B-II method) in 31 patients, Billroth I method (B-I method) in 17, Roux-en-Y method (Roux-Y method) in 3, and esophagogastrostomy in 1. The period between gastrectomy and discovery of gallstones was 1-5 years in 9, 5-10 years in 10, and 10 years or longer in 33, or more than 60% of the patients. Gallstones were present in the gallbladder alone in 33, bile duct alone in 9, gallbladder and bile duct in 10; the percentage of bile duct stones was high. The type of stones was bilirubin-calcium stones in 21, black stones in 12, pure cholesterol stones in 1, combined stones in 4, mixed stones in 12, and others in 2; pigment stones accounted for 63.5%. Gallstones were symptomatic in 78.8% of the patients, and abdominal pain was the most frequent symptom. Bile was positive on bacterial culture in 68.4%, and Gram-negative bacilli were the most frequently isolated. Lymph node dissection, vagotomy, cholestasis, and biliary tract infection are considered to be related to cholelithiasis after gastrectomy.
Incidence of symptomatic cholelithiasis after laparoscopic sleeve gastrectomy and its association with rapid weight loss.
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association
BACKGROUND/AIM:The worldwide prevalence of obesity has increased dramatically over the past years. In the Arab region, 66%-75% of adults and 25%-40% of children are either overweight or obese. Bariatric surgery has become the most effective approach for managing obesity and its co-morbidities. An expected outcome of bariatric surgery is cholelithiasis, which is one of the established risk factors of rapid weight loss. The aim of this study is to detect the incidence of symptomatic cholelithiasis among bariatric patients. PATIENTS AND METHODS:A retrospective cohort study on 711 patients aged between 18 and 60 who underwent laparoscopic sleeve gastrectomy (LSG) was conducted at King Saud University Medical City from January 2016 to January 2018. RESULTS:The postoperative incidence of symptomatic cholelithiasis was 3.5%. The mean duration of symptom development was 12.4 months. The rates of weight loss at 6 and 12 months for patients with symptomatic cholelithiasis were 28.94 ± 4.89% and 38.51 ± 6.84%, respectively (P = 0.002), which were significantly higher than in patients without symptomatic cholelithiasis during the same follow-up period (24.41 ± 6.6% and 32.29 ± 10.28%), respectively; (P = 0.012). CONCLUSION:We found a 3.5% incidence of symptomatic cholelithiasis among post-LSG patients in a period of 2 years. Rapid weight loss was the only risk factor that contributed to the development of post-LSG gallbladder disease. STATISTICAL ANALYSIS USED:Results were expressed as absolute numbers and percentages for categorical variables and as mean and standard deviation for continuous variables. A paired sample t-test was performed to determine significant differences between means at different time stamps. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 23.0.
10.4103/sjg.SJG_472_19
Pylorus-preserving gastrectomy: effect on resistance through the sphincter of Oddi compared to conventional distal gastrectomy in dogs.
World journal of surgery
Bile stasis is an important etiologic factor in the high incidence of postgastrectomy gallstone disease (PGGD). Our previous study showed that duodenal, but not prepyloric, transection disturbed the motility of the sphincter of Oddi (SO) in anesthetized dogs. We had developed pylorus-preserving gastrectomy (PPG), in which the anal margin of the resected stomach is the prepyloric portion, not the duodenum. The present study evaluated the usefulness of PPG for reducing bile stasis, which may induce PGGD. We examined the resistance of bile flow through the SO using dogs that had undergone either PPG (n = 5) or conventional distal gastrectomy ( B-I) (n = 5). Four weeks after gastrectomy we anesthetized the animals and compared the basal and volume load-induced pressure in the common bile duct (CBD) between groups with or without administration of cholecystokinin-8 (CCK8). Flow resistance of the SO was evaluated by measuring flow volume through the SO following a graded pressure load to the CBD. The basal pressure and the threshold pressure to open the SO were significantly lower in PPG dogs than in B-I dogs independent of CCK8 administration. There were no significant differences between groups in regard to volume load-induced pressure elevation or the resistance of the SO. These results indicate that PPG may be more useful for reducing the incidence of PGGD than conventional distal gastrectomy, possibly through attenuating resistance to bile flow.
10.1007/s00268-001-0276-0
Gallbladder motility in vitro in men with gallstones following Billroth II gastric resection.
Maselli M A,Pezzolla F,Piepoli A L,Caruso M L,Lorusso D
Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society
Gastric surgery induces an increased incidence of gallstones. To investigate the changes in gallbladder kinetics after gastric resection, 20 male patients were studied: ten patients undergoing cholecystectomy for gallstones developed after Billroth II gastric resection and ten patients undergoing cholecystectomy for cholelithiasis without previous abdominal surgery. Longitudinal strips from the gallbladder wall were suspended in an organ bath and the isometric tension recorded. Dose-response curves to cholecystokinin-octapeptide and carbachol were obtained. Half the maximal response to cholecysto-kinin-octapeptide was 0.50 +/- 0.11 x 10(-7) M in the first group and 1.36 +/- 0.37 x 10(-7) M in the second group (P < 0.05). The ED50 to carbachol was 24.33 +/- 2.69 x 10(-7) M in the gastrectomy group and 40.39 +/- 5.01 x 10(-7) M in the control group (P < 0.01). There was no significant difference in the maximal contractile response either to cholecystokinin-octa-peptide or carbachol in the two groups. Our study shows an increased gallbladder sensitivity to cholecystokinin-octapeptide and carbachol in patients with gallstones developed after Billroth II gastric resection.
10.1111/j.1365-2982.1996.tb00239.x
Effect of vagotomy on cholecystokinin release and gallbladder contraction in patients with complicated duodenal ulcer.
Huang Y S,Huang T J,McKay D,Rayford P L
European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes
In this prospective study, we investigated gallbladder (GB) contraction and plasma cholecystokinin (CCK) levels in response to food intake before and 1 month after vagotomy in 27 patients with complicated duodenal ulcer. Highly selective vagotomy (HSV) was carried out in 6 patients, truncal vagotomy and pyloroplasty (TVP) in 4, truncal vagotomy and antrectomy (TVA) in 7, selective vagotomy and pyloroplasty (SVP) in 5 and selective vagotomy and antrectomy (SVA) in another 5 patients with pyloric stenosis. The results of our studies indicated that (1) basal plasma CCK levels increased significantly after vagotomy, (2) none of the vagotomy operations altered the integrated CCK response, (3) unlike HSV, SVA and TVA, SVP and TVP decreased GB emptying and (4) antrectomy significantly enhanced CCK release after food intake. We concluded from these findings that the operative procedure of HSV, SVA or TVA to circumvent bile stasis-related postvagotomy cholelithiasis is superior to SVP or TVP in the surgical treatment of complicated duodenal ulcer.
10.1159/000129357
[Contractile function of the gallbladder after gastrectomy].
Ao Y F
Zhonghua wai ke za zhi [Chinese journal of surgery]
Gallbladder contractile function was observed by B-mode ultrasonography on patients with radical gastrectomy for gastric carcinoma (20 cases), with subtotal gastrectomy for peptic ulcer (36 cases), and with highly selective vagotomy (7 cases). Thirty-one preoperative patients with peptic ulcer were used as control. It was found that within one month after radical or subtotal gastrectomy the average area and the volume of the gallbladder became much larger than that found in control group. The empty rate of the gallbladder was found decreased and the remainder bile increased. Early stage gallstones were found in two cases 11 and 13 months after gastrectomy. The inner diameter of the common bile duct was increased after radical gastrectomy. No definite relationship was found between gallbladder contractile disfunction and the mode of gastroenterostomy. It was also found that highly selective vagotomy had only slight influence on the biliary tract. These results suggest that gastrectomy has significant influence on the function of biliary tract and plays an important role in the formation of gallstones.
Factors Influencing Gallstone Formation: A Review of the Literature.
Biomolecules
Gallstone disease is a common pathology of the digestive system with nearly a 10-20% incidence rate among adults. The mainstay of treatment is cholecystectomy, which is commonly associated with physical pain and may also seriously affect a patient's quality of life. Clinical research suggests that cholelithiasis is closely related to the age, gender, body mass index, and other basic physical characteristics of patients. Clinical research further suggests that the occurrence of cholelithiasis is related to obesity, diabetes, non-alcoholic fatty liver, and other diseases. For this reason, we reviewed the following: genetic factors; excessive liver cholesterol secretion (causing cholesterol supersaturation in gallbladder bile); accelerated growth of cholesterol crystals and solid cholesterol crystals; gallbladder motility impairment; and cardiovascular factors. Herein, we summarize and analyze the causes and mechanisms of cholelithiasis, discuss its correlation with the pathogenesis of related diseases, and discuss possible mechanisms.
10.3390/biom12040550
Research progress on the immune microenvironment of the gallbladder in patients with cholesterol gallstones.
World journal of gastrointestinal surgery
Cholesterol gallstones are very common in hepatobiliary surgery and have been studied to a certain extent by doctors worldwide for decades. However, the mechanism of cholesterol gallstone formation is not fully understood, so there is currently no completely effective drug for the treatment and prevention of cholesterol gallstones. The formation and development of cholesterol gallstones are caused by a variety of genetic and environmental factors, among which genetic susceptibility, intestinal microflora disorders, impaired gallbladder motility, and immune disorders are important in the pathogenesis of cholesterol gallstones. This review focuses on recent advances in these mechanisms. We also discuss some new targets that may be effective in the treatment and prevention of cholesterol gallstones, which may be hot areas in the future.
10.4240/wjgs.v14.i9.887
Clinical assessments in patients ten years after pylorus-preserving gastrectomy with or without preserving both pyloric and hepatic branches of the vagal nerve for early gastric cancer.
Tomita Ryouichi,Fujisaki Shigeru,Koshinaga Tsugumichi,Kusafuka Takeshi
Hepato-gastroenterology
BACKGROUND/AIMS:To clarify the differences in the postoperative quality of life (QOL) of patients after pylorus preserving gastrectomy (PPG) between those with preserved pyloric and hepatic branches of the vagal nerve (PHV) and those without PHV, we investigated the postoperative gastrointestinal symptoms at 10 years after PPG patients with or without PHV. METHODS:Twenty eight subjects who underwent PPG with D2 lymphadenectomy without preserving the PHV (group A: 18 male and 10 female subjects aged 38 to 70 years with a mean age of 60.2 years) were interviewed to inquire about gastrointestinal symptoms (appetite, weight loss, epigastric fullness, reflux esophagitis, and early dumping syndrome), and compared with 30 PPG patients with D1 lymphadenectomy with preserving PHV (group B: 20 male and 10 female subjects aged 33 to 72 years with a mean age of 61.3 years). Esophagogastric endoscopy and abdominal ultrasonography were also studied. RESULTS:There were no differences in the postoperative gastrointestinal symptoms, endoscopic reflux esophagitis, and endoscopic gastritis between groups A and B. However, cholecystolithiasis was significantly found in group A but was not found in group B. In addition, there was significant difference between groups A and B (p = 0.0074). CONCLUSIONS:It is important to preserve the PHV to prevent cholecystolithiasis formation in patients after PPG.
Total gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of hepatic vagus branch and lower esophageal sphincter for T2 gastric cancer without lymph node metastasis.
Tomita Ryouichi,Tanjoh Katsuhisa,Fujisaki Shigeru
Hepato-gastroenterology
BACKGROUND/AIMS:In order to improve postgastrectomy disorders of patients with T2 (MP or SS) gastric cancer without lymph node metastasis, which mainly locates in the middle third of stomach, we have performed a total gastrectomy preserving both hepatic vagus branches and the lower esophageal sphincter as a function-preserving surgical procedure. METHODOLOGY:In the present study, the application criteria and points of the technique are outlined, and postoperative quality of life is clinically investigated. Twenty-four subjects who underwent this surgical operation (group A; 16 men and 8 women subjects aged 46 to 73 years, mean age 62.2 years) were interviewed regarding appetite, weight loss, reflux esophagitis, dumping syndrome, and microgastria. Cholelithiasis following total gastrectomy was also checked by abdominal ultrasonography. Group A was compared with 26 cases of conventional total gastrectomy with D2 lymphadenectomy, excision of lower esophageal sphincter, total vagotomy, and single jejunal interposition (B group; 19 men and 7 women subjects aged 42 to 75 years, mean age 64.8 years). Application criteria of the technique: Included were cases with T2 cancer of N0 mainly localizing at the middle-third of the stomach which was 4 cm or further in distance from the oral-side margin of the cancer to the esophagogastric mucosa junction. Points of the technique: In lymphadenectomy, hepatic branches of the vagal nerve only preserved. To preserve lower esophageal sphincter, the abdominal esophagus was severed at the level of His angle to the longitudinal axis of the esophagus. Substitute stomach was created as a 15-cm jejunal pouch with a 5-cm-long jejunal conduit for isoperistaltic movement. RESULTS:In group A the food ingestion rate was significantly greater than that of group B (P<0.001) at 6 months and 2.0 years after operation, with no reflux esophagitis or dumping syndrome being noticed at 2.0 years after operation. In group B, loss of appetite 2.0 years after operation was significantly higher than that in group A (P<0.01). In addition, symptomatic reflux esophagitis (heartburn, dyspepsia, regurgitation) developed more significantly in group B than in group A (P<0.05). For food ingestion per time, group B was significantly delayed compared with group A (P<0.05). Body weight loss in group B was significantly higher than that in group A (P<0.01). Postgastrectomy cholelithiasis was detected significantly more in group B than in group A (P<0.05). CONCLUSIONS:These results suggested that the surgical technique proposed is safe and leads to a satisfactory symptomatic and nutritional result, and that this procedure is a function-preserving gastric surgery appropriate to prevent postgastrectomy disorders of subjects for T2 gastric cancer without lymph node metastasis, mainly located in the middle-third of stomach.
Vagal Sparing Gastrectomy: A Systematic Review and Meta-Analysis.
Digestive surgery
INTRODUCTION:Radical gastrectomy is associated with significant functional complications. In appropriate patients may be amenable to less invasive resection aimed at preserving the vagal trunks. The aim of this systematic review and meta-analysis was to assess the functional consequences and oncological safety of vagal sparing gastrectomy (VSG) compared to conventional non-vagal sparing gastrectomy (CG). METHODS:A systematic review of four databases in accordance with PRISMA guidelines was undertaken for studies published between January 1, 1990, and December 15, 2021, comparing patients who underwent VSG to CG. We meta-analysed the following outcomes: operative time, blood loss, nodal yield, days to flatus, body weight changes, as well as the incidence of post-operative cholelithiasis, diarrhoea, delayed gastric emptying, and dumping syndrome. RESULTS:Thirty studies were included in the meta-analysis with a selection of studies qualitatively analysed. VSG was associated with a lower rate of cholelithiasis (OR: 0.25, 95% CI: 0.15-0.41, p < 0.010) and early dumping syndrome (OR: 0.42, 95% CI: 0.21-0.86; p = 0.02), less blood loss (mean difference [MD]: -51 mL, 95% CI: -89.11 to -12.81 mL, p = 0.009), less long-term weight loss (MD: 2.03%, 95% CI: 0.31-3.76%, p = 0.02) and a faster time to flatus (MD: -0.42 days, 95% CI: -0.48 to 0.36, p < 0.001). There was no significant difference in nodal harvest, overall survival, and all other endpoints. CONCLUSION:VSG significantly reduces the incidence of post-operative cholelithiasis and dumping syndrome, decreases weight loss, and facilitates an earlier return of gut motility. Although technically more challenging, VSG should be considered for prophylactic surgery.
10.1159/000536472
Control of gallbladder contractions by cholecystokinin through cholecystokinin-A receptors in the vagal pathway and gallbladder in the dog.
Sonobe K,Sakai T,Satoh M,Haga N,Itoh Z
Regulatory peptides
The mechanism of CCK action on gallbladder contractions in the physiological condition is unclear. Gallbladder contractions were monitored by means of chronically implanted force transducers in conscious dogs. Postprandial gallbladder contractions were partially inhibited by atropine and hexamethonium, and completely inhibited by devazepide. In vitro contractile response of canine gallbladder muscle strips to CCK-8 was also studied. CCK-8-induced muscle strip contraction was atropine and tetrodotoxin resistant, but was completely eliminated by devazepide. The existence of CCK receptors in the vagal nerve and gallbladder was examined by means of autoradiography. Forty-eight hours after ligation of the abdominal vagus, CCK-8 binding sites were found to accumulate in the subdiaphragmatic vagal nerve immediately proximal to the ligature, and similar binding sites were also found in the gallbladder smooth muscle layer. These binding sites were displaced by the addition of 10(-7) mol/1 unlabeled CCK-8 and devazepide, but L-365,260 had no effect. In conclusion, it is considerable that postprandial CCK-induced gallbladder contractions are controlled through CCK-A receptors both on the vagal nerve in stimulating endogenous release of acetylcholine and on the gallbladder directly to stimulate muscle contraction in the dog.
Release of cholecystokinin and gallbladder contraction before and after gastrectomy.
Inoue K,Fuchigami A,Hosotani R,Kogire M,Huang Y S,Miyashita T,Suzuki T,Tsuda K,Seino Y,Rayford P L
Annals of surgery
The contraction of the gallbladder by ultrasonography and release of cholecystokinin (CCK) by specific radioimmunoassay in response to the ingestion of oral fatty meal before and 1 month after gastrectomy in five patients with early gastric cancer was studied. Before gastrectomy, basal concentrations of CCK (13.4 +/- 2.3 pmol/L) rose significantly to a maximum of 23.3 +/- 3.6 pmol/L at 20 minutes after ingestion of oral fatty meal, and remained significantly elevated during the study. Gallbladder contraction began as CCK concentrations rose, demonstrating significant correlation with plasma CCK. One month after gastrectomy, CCK showed a rapid and greater response to the ingestion of fatty meal, attaining a maximum of 53.7 +/- 7.3 pmol/L at 10 minutes, then gradually falling to basal level. The maximal contraction of the gallbladder after gastrectomy was almost the same as before gastrectomy (62.7 +/- 4.0% of original area), showing a significant correlation with plasma CCK, but refilling of the gallbladder was induced earlier with corresponding reduction of plasma CCK. Simultaneous measurement of plasma concentrations of pancreatic polypeptide revealed a fairly similar response to plasma CCK before and after gastrectomy. The release of CCK is the chief mechanism by which the ingestion of a fatty meal causes contraction of the gallbladder even after gastrectomy as well as before gastrectomy.
Long-term effectiveness of preserved celiac branch of vagal nerve after Roux-en-Y reconstruction in laparoscopy-assisted distal gastrectomy.
Inokuchi Mikito,Sugita Hirofumi,Otsuki Sho,Sato Yuya,Nakagawa Masatoshi,Kojima Kazuyuki
Digestive surgery
BACKGROUND:The aim of this retrospective cohort study was to clarify the effectiveness of preserving the celiac branch (CB) of the vagal trunk after the Roux-en-Y (R-Y) reconstruction in laparoscopy-assisted distal gastrectomy (LADG). METHODS:One hundred twenty patients with pathological stage I gastric cancer underwent R-Y reconstruction after LADG with D1 + β lymphadenectomy between January 2004 and March 2009 and were followed up for 5 years. The patients were divided into 2 groups: the preservation group (P-CB) and the resection group (R-CB). Evaluated variables included symptoms, endoscopic findings, nutritional status, and gallstone formation at 5 years after gastrectomy. RESULTS:Gallstone formation was significantly less common in P-CB than in R-CB (16 vs. 33%, p = 0.035). One patient (2%) in P-CB and 4 (7%) in R-CB underwent surgery for symptomatic gallstones. On multivariate analysis of gallstone formation, R-CB was an independent risk factor for gallstone formation (odds ratio = 2.5, 95% confidential interval: 1.0-6.1, p = 0.049). Symptoms and endoscopic findings did not differ significantly between the groups. Relative values of body weight, serum albumin level, and total cholesterol level also did not significantly differ between the groups. CONCLUSION:Preserving the CB independently contributes to the prevention of gallstone formation during long-term follow-up after R-Y reconstruction following LADG.
10.1159/000368703
Efficacy of Celiac Branch Preservation in Billroth-Ⅰ Reconstruction After Laparoscopy-Assisted Distal Gastrectomy.
Liu Yaofu,Cui Xinye,Zhang Yi,Cao Liang,Hu Xiang
The Journal of surgical research
BACKGROUND:The goal of the present retrospective study was to elucidate the efficacy of conserving the celiac branch (CB), which can reduce the adverse reactions of Billroth-Ⅰ (B-Ⅰ) restoration after the laparoscopy-assisted distal gastrectomy (LADG). METHODS:Two hundred thirty-three patients with gastric cancer underwent B-Ⅰ reconstruction after LADG with dissection 2 lymphadenectomy from July 2005 to July 2012 and were monitored for 5 y. The patients were separated into 2 groups: celiac branch preserved (P-CB) group (n = 98) and celiac branch resected (R-CB) group (n = 135). In addition to patient information, tumor features, and surgical details, short-term and long-term variables such as bowel condition, surgical complications, and endoscopy findings were evaluated. RESULTS:In short-term efficacy, the time of first flatus and liquid ingestion were slightly shorter in the P-CB group than in the R-CB group (3.84 ± 0.74 versus 4.38 ± 0.71, P = 0.0001; 5.04 ± 1.07 versus 5.67 ± 1.10, P = 0.0001). For long-term efficacy, the incidences of chronic diarrhea, gastroparesis, residual food, bile reflux, and reflux esophagitis were less in the P-CB group compare with the R-CB group (6.1% versus 22.2%, P = 0.001; 5.1% versus 17.8%, P = 0.004; 4.1% versus 17.8%, P = 0.004; 8.2% versus 17.8%, P = 0.036; 8.2% versus 17.8%, P = 0.036). Other parameters such as postoperative ileus and gallstones had a better efficacy trend in the P-CB group but did not suggestively vary among the groups. CONCLUSIONS:The CB has an imperative part in the gastrointestinal motility, and celiac preservation mainly exerts long-term efficacy in patients who underwent B-I surgery with LADG.
10.1016/j.jss.2019.07.074
[Value of radical dissection with vagus nerve preservation for proximal gastric cancer].
Sun Peng-da,Cao Hong,Zhu Jia-Ming,Fang Xue-Dong
Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery
OBJECTIVE:To study the feasibility and influence of vagus nerve preservation in radical operation for proximal gastric cancer. METHODS:Thirty-two patients with early or T2 cardia cancer from May 2007 to May 2009 were enrolled and randomized into two groups, i.e. vagus nerve preservation group(n=16) and control group(n=16). Two groups were compared with regard to operative time, anastomotic fistula, digestive discomforts, body weight, survival rate, findings on gastroscope and abdominal ultrasonography. RESULTS:There were no statistically significant differences between the two groups in operative time (2.8 vs. 2.5 h), postoperative complications rate (25.0% vs. 31.3%). No recurrence or mortality was observed after one-year follow-up. However, patients who underwent vagus nerve preservation had less postprandial discomforts(3 vs. 12 cases), bile reflux(3 vs. 10 cases), atrophic gastritis(1 vs. 9 cases), gallstones(1 vs. 8 cases), body mass index, and diarrhea(P<0.05). CONCLUSION:For patients with early gastric cancer, preservation of the vagus nerve during radical gastrectomy results in less complications and does not compromise patient survival.
Factors for postoperative gallstone occurrence in patients with gastric cancer: a meta-analysis.
Chen Xiang-Jun,Li Nian,Huang Ying-De,Ren Shuang,Liu Fang,Chen Lian,Wang Yong,Chen Min
Asian Pacific journal of cancer prevention : APJCP
OBJECTIVE:To evaluate risk factors for gallstones after gastrectomy. METHODS:To identify documents published from 1990 to 2011 the Pubmed, Cochrane Library, Springer Link, CBM and WanFang databases were searched and a meta-analysis was performed with RevMan 5.2 software for odds ratios and 95%CIs. RESULTS:Fifteen studies were selected for the meta-analysis. The pooled ORs [95%CIs] were 0.56 [0.43, 0.73], (P<0.0001) for digestive tract reconstruction, 0.80 [0.54, 1.17], (P=0.25) for pylorus preservation, 0.33[0.15, 0.75], (P=0.008) for resection scope of stomach, 0.33 [0.15, 0.75], (P=0.008) for lymphadenectomy, and 0.13 [0.05, 0.33], (P<0.0001) for vagotomy. CONCLUSIONS:Digestive tract physical reconstruction and vagus nerve preservation can reduce the morbidity of gallstones after gastrectomy. Total gastrectomy can add to the morbidity of galltones as does increasing the degree of lymph node dissection. There was no significant difference in gallstones with or without pylorus preservation.
10.7314/apjcp.2014.15.2.877
The Effect of Minimally Invasive Gastrectomy for Gastric Cancer on Postoperative Gallstone Formation.
Ikegame Ko,Hikage Makoto,Fujiya Keiichi,Kamiya Satoshi,Tanizawa Yutaka,Bando Etsuro,Notsu Akifumi,Terashima Masanori
World journal of surgery
BACKGROUND:Gallstones are known to occur quite frequently after gastrectomy. Most of the studies about postoperative cholelithiasis have focused on open gastrectomy, whereas laparoscopic gastrectomy has recently gained popularity as a type of minimally invasive surgery (MIS). Hence, the efficacy of MIS in preventing post-gastrectomy gallstone formation remains to be elucidated. This study aimed to evaluate the risk of gallstone formation after MIS for clinical stage I/IIA gastric cancer. METHODS:A total of 1166 patients undergoing gastrectomy for clinical stage I/IIA gastric cancer between 2009 and 2016 were included in this study. Gallstones were detected on abdominal ultrasound and/or computed tomography. Multivariate logistic regression analysis was used to determine factors associated with postoperative gallstone formation. RESULTS:Gallstone formation was observed in 174 patients (15%), of whom 22 (2%) experienced symptomatic cholelithiasis. In multivariate analysis, the following were identified as risk factors for post-gastrectomy gallstone formation: open approach with an odds ratio (OR) of 1.670 and a 95% confidence interval (CI) of 1.110-2.510 (P = 0.014), older age (OR 1.880; 95% CI 1.290-2.730; P < 0.001), high body mass index (OR 1.660; 95% CI 1.140-2.420; P = 0.008), Roux-en-Y (RY) reconstruction (OR 1.770; 95% CI 1.230-2.530; P = 0.002), hepatic branch vagotomy (OR 1.600; 95% CI 1.050-2.440; P = 0.029), and intra-abdominal infectious complications (OR 3.040; 95% CI 1.680-5.490; P < 0.001). CONCLUSION:Our study suggested that MIS along with the preservation of the hepatic vagus nerve and non-RY reconstruction could help prevent post-gastrectomy gallstone development.
10.1007/s00268-021-06270-6
Functional evaluation after vagus-nerve-sparing laparoscopically assisted distal gastrectomy.
Kojima Kazuyuki,Yamada Hiroyuki,Inokuchi Mikito,Kawano Tatuyuki,Sugihara Kenichi
Surgical endoscopy
BACKGROUND:Vagus nerve-sparing laparoscopically assisted distal gastrectomy (Vs-LADG) for early gastric cancer has been introduced to reduce postgastrectomy syndrome, but its clinical and functional outcomes remain unclear. METHODS:Of the 105 patients reviewed in this study, 75 underwent Vs-LADG and 30 underwent laparoscopically assisted distal gastrectomy (LADG) for gastric cancer between January 1999 and May 2006. The clinical and functional outcomes of these two groups were compared. RESULTS:The clinical and pathologic background between the two groups did not differ. The incidence of gallstone was significantly lower in the Vs-LADG group than in the LADG group (p < 0.05), but no differences existed in duration of surgery, intraoperative blood loss, number of retrieved lymph nodes, time to first flatus after surgery, or length of hospital stay between the two groups. CONCLUSIONS:As shown by the findings, Vs-LADG is a safe and minimally invasive surgery that may decrease the incidence of gallstone formation after gastrectomy.
10.1007/s00464-008-0016-8
Surgical technique of vagus nerve-preserving gastrectomy with D2 lymphadenectomy for gastric cancer.
Ando Shigemitsu,Tsuji Hideki
ANZ journal of surgery
Preservation of the vagus nerve in curative gastrectomy for gastric cancer is important to maintain postoperative quality of life. We developed a vagus nerve-preserving gastrectomy with D2 dissection for patients with early gastric cancer and for selected patients with T2 cancer. Following lymph node dissection along the left gastric artery, the root of the left gastric artery was isolated and divided. The coeliac branch was followed retrogradely, and the posterior gastric branches were cut at their origins. The hepatic branch was also preserved. A total of 136 patients, including 27 cases of T2 cancer, underwent the vagus nerve-preserving gastric operation, and surgical anatomy of the coeliac branch was studied. In 110 cases, variations in the course of the coeliac branch were classified into three types according to its relationship with the left gastric artery: close to the artery (43 cases, 39.1%), intermediate (47 cases, 42.7%) and away from the artery (20 cases, 18.2%). In 115 patients who underwent vagus nerve-preserving distal gastrectomy (n = 93) or pylorus-preserving gastrectomy (n = 22), the postoperative bodyweight was 95.6 +/- 5.2% of the preoperative bodyweight, and the incidence of gallstone formation was 1.8% (2 of 113). A D2 dissection comparable with conventional D2 gastrectomy could be carried out using the vagus nerve-preserving technique. The coeliac branch could be preserved regardless of its anatomy, resulting in improvements in postoperative quality of life.
10.1111/j.1445-2197.2007.04396.x
Related factors of postoperative gallstone formation after distal gastrectomy: A meta-analysis.
Chen Y,Li Y
Indian journal of cancer
AIM:The aim of this study was to evaluate the risk factor of gallstone occurrence after distal gastrectomy (DG) for gastric cancer. METHODS:Relevant documents published from 2000 to 2016 were retrieved in PubMed, Web of Knowledge, and Ovid's database, and a metaanalysis was performed with RevMan 5.0 software for odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS:Eight studies met the final inclusion criteria. From the pooled analyses, nonphysiological reconstruction (OR = 1.51; 95% CI = 1.10-2.08; P = 0.01) and vagus nerve resection (OR = 2.79; 95% CI = 1.57-4.96; P = 0.0005) were significantly associated with increased risk of gallstone after DG. CONCLUSION:Our analysis indicated that digestive tract reconstruction and vagus nerve resection were strongly and consistently associated with gallstone formation after DG.
10.4103/ijc.IJC_91_17
A Gastrectomy for early-stage gastric cancer patients with or without preserving celiac branches of vagus nerves: A meta-analysis.
Surgery
BACKGROUND:Vagus nerve-preserving gastrectomy is increasingly popular in treating gastric cancer in the early stage, however the long and short-term outcomes after gastrectomy while preserving the celiac branch of the vagus nerve are not well defined. We aimed to summarize and compare perioperative and longer-term outcomes after celiac branch vagus nerve-preserving gastrectomy (CBP, preserving both the celiac and hepatic branches of the vagus nerve), compared to those without CBP (non-CBP, only the hepatic branch of the vagus nerve is preserved). METHODS:We searched the Embase, PubMed, Cochrane Library and Web of Science databases for papers published before October 2021. The primary results were evaluated by short-term and long-term postoperative complications, whereas the secondary outcomes included surgery-related parameters, recovery-related parameters and overall survival. Random-effects or fixed-effects model were used to estimate odds ratio, and weighted mean difference for the outcomes. The underlying publication bias was identified via funnel charts, Begg's test and Egger's test. Sensitivity analysis was conducted by removing the research one by one. RESULTS:A total of 9 studies consisting of 8 retrospective studies and one randomized control trial were included. The analysis included 1,109 patients, with 568 (51.2%) of patients receiving CBP and 541 (48.8%) patients who received non-CBP. The CBP group had a shorter time in terms of first flatus (weighted mean difference = -0.436, 95% confidence interval: -0.603 to -0.269; P < 0.001) and hospital stay (weighted mean difference = -0.456, 95% confidence interval: -0.874 to -0.037, P = 0.033) than the non-CBP group, but the time to the start of oral intake was comparable between the groups. Regarding short-term complications and surgery-related parameters, between CBP and non-CBP, no evident differences were observed in pancreatic complications, anastomotic leakage, postoperative bleeding, operation time, blood loss or lymph nodes examined. In terms of long-term complications, the incidence of gallstones in CBP was lower than that in non-CBP (odds ratio = 0.582, 95% confidence interval: 0.356-0.953, P = 0.031), and the incidence of bile reflux in CBP was lower than that in non-CBP (odds ratio = 0.473, 95% confidence interval: 0.280-0.800, P = 0.005). However, the prevalence rates of diarrhea, early dumping syndrome, esophageal reflux, and delayed gastric emptying were comparable between CBP and non-CBP. CONCLUSION:The present research showed that gastric cancer patients in the early stage under CBP were superior to those without CBP in terms of incidence of gallstones, bile reflux, time of first flatus and hospital stay. Furthermore, it is imperative to conduct randomized control studies with larger sample sizes to determine the oncological survival outcomes when preserving the celiac branch.
10.1016/j.surg.2022.10.016
Vagus Nerve Preservation for Early Distal Gastric Cancer With Monitoring and Indocyanine Green Labeling: A Randomized Clinical Trial.
JAMA surgery
Importance:Radical gastric cancer surgery can cause functional and physiological disorders due to the resection of perigastric vagus nerves. Few studies have used intraoperative neurophysiological monitoring and indocyanine green (ICG) labeling to preserve the perigastric vagus nerve and to evaluate the corresponding effects. Objective:To assess the feasibility and effects of vagus nerve preservation using neurophysiologic monitoring and ICG labeling during laparoscopic distal gastrectomy in patients with early distal gastric cancer. Design, Setting, and Participants:This open-label, prospective randomized clinical trial initially enrolled 285 patients with clinical stage cT1N0M0 distal gastric cancer from May 2022 to May 2023. This trial was conducted at Qilu Hospital of Shandong University in Jinan, China, and enrolled patients aged 18 to 80 years with histologically proven gastric adenocarcinoma scheduled for distal gastrectomy. The final follow-up examination was performed May 1, 2024. Interventions:Eligible participants were randomly assigned 1:1 to vagus nerve preservation distal gastrectomy (VPG) or vagus nerve resection distal gastrectomy (VRG). Main Outcomes and Measures:The primary outcome was the incidence of postsurgical gastroparesis. Secondary outcomes included postoperative gallstone formation, quality of life, morbidity, mortality, overall survival, and disease-free survival up to 12 months postoperatively. All analyses were based on both intention-to-treat and per-protocol analyses. Results:Of 264 patients included in the intention-to-treat analysis, the median (IQR) patient age was 58.0 (52.0-67.0) years, and 67 patients (25.4%) were female. Both the VPG and VRG groups included 132 patients. Postoperative gastroparesis occurred in 1 patient (0.8%) in the VPG group and in 10 patients (7.6%) in the VRG group. Gallstones developed in 0 patients in the VPG group and in 9 patients (6.8%) in the VRG group. As assessed by mean (SD) score on the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the VRG group experienced more nausea and vomiting at 6 months postsurgery (19.38 [7.62]) than the VPG group (17.15 [9.21]) (P = .03) and had significantly higher rates of persistent appetite loss, reflux symptoms, and eating difficulties at both 6 months and 12 months than the VPG group. Differences in postoperative complications and metastasis were not significant. Conclusions and Relevance:Neurophysiologic monitoring and ICG labeling during distal laparoscopic gastrectomy for vagus nerve preservation in patients with early distal gastric cancer are safe and feasible. Preserving the perigastric vagus nerve may retain the function of the remnant stomach and improve quality of life. Trial Registration:Chictr.org.cn Identifier: ChiCTR2200059489.
10.1001/jamasurg.2024.5077
Preservation of hepatic branch of the vagus nerve reduces the risk of gallstone formation after gastrectomy.
Wang Chao-Jie,Kong Seong-Ho,Park Ji-Hyeon,Choi Jong-Ho,Park Shin-Hoo,Zhu Chun-Chao,Alzahrani Fadhel,Alzahrani Khalid,Suh Yun-Suhk,Park Do-Joong,Lee Hyuk-Joon,Cao Hui,Yang Han-Kwang
Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
BACKGROUND:Injury to the vagus nerve has been proposed to be associated with occurrence of gallstones after gastrectomy. We investigated the effect of preservation of hepatic branch of the vagus nerve on prevention of gallstones during laparoscopic distal (LDG) and pylorus-preserving gastrectomy (LPPG). METHODS:Preservation of the vagus nerve was reviewed of cT1N0M0 gastric cancer patients underwent LDG (n = 323) and LPPG (n = 144) during 2016-2017. Presence of gallstones was evaluated by ultrasonography (US) and computed tomography (CT). Incidences of gallstones were compared between the nerve preserved (h-DG, h-PPG) group and sacrificed (s-DG, s-PPG) group. Clinicopathological features were also compared. RESULTS:The 3-year cumulative incidence of gallstones was lower in the h-DG (2.7%, n = 85) than the s-DG (14.6%, n = 238) (p = 0.017) and lower in the h-PPG (1.6%, n = 123) than the s-PPG (12.9%, n = 21) (p = 0.004). Overall postoperative complication rate was similar between the h-DG and s-DG (p = 0.861) as well as between the h-PPG and s-PPG (p = 0.768). The number of retrieved lymph nodes station #1 and 3-year recurrence-free survival were not significantly different between the preserved group and sacrificed group. Injury to the vagus nerve (p = 0.001) and high body mass index (BMI) (≥ 27.5 kg/m) (p = 0.040) were found to be independent risk factors of gallstone formation in multivariate analysis. CONCLUSIONS:Preservation of hepatic branch of the vagus nerve can be recommended for LDG as well as LPPG of early gastric cancer patients to reduce postoperative gallstone formation.
10.1007/s10120-020-01106-z