Autonomic nerve preserving distal gastrectomy in the laparoscopic gastrectomy—the technique and results of preserving a celiac branch

Abstract

We perform autonomic nerve preserving distal gastrectomy in laparoscopic gastrectomy for early gastric cancer in order to decreas the invasiveness and to preserve functions. In this paper, we particularly describe a technique and results of preserving a celiac branch of the vagus nerve. A total of 150 patients had laparoscopic distal gastrectomy (Billroth-I reconstruction by delta-shaped anastomosis) in our institution between May 2001 to February 2008, and among of them 84 nerve-preserved and 45 nerve-unpreserved patients who could be followed were subjected to a questionnaire survey as well as to an endoscopic evaluation. The results demonstrated that nerve-unpreserved patients were more likely to change bowel habit soft (20.5% vs. 44.4%), and to complain reflux symptoms (17.9% vs. 33.3%, with a significant difference). A significantly frequent occurrence of bile reflux was also noted in the unpreserved patients by gastro-endoscopy (44.1% vs. 62.2%). Although there were some differences in the background factors between both groups, we consider that some postoperative sequel such as diarrhea and bile reflux might be capable of decreasing by this nerve-preserving gastrectomy.