Vagus nerve-preserving versus conventional laparoscopic splenectomy and azygoportal disconnection
Background Conventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to the vagal nerve. We have developed vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection (VLSD). This study aimed to...
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Published in | Surgical endoscopy Vol. 32; no. 6; pp. 2696 - 2703 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer US
01.06.2018
Springer Nature B.V |
Subjects | |
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Abstract | Background
Conventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to the vagal nerve. We have developed vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection (VLSD). This study aimed to evaluate whether VLSD is effective and safe, and to determine whether a reduction in the incidence of postoperative complications improves postoperative quality of life compared with CLSD.
Methods
We retrospectively evaluated outcomes in 72 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism who underwent CLSD (
n
= 40) or VLSD (
n
= 32) between April 2015 and December 2016. Their demographic, intraoperative, and postoperative variables were compared.
Results
No patients required conversion to laparotomy in CLSD and VLSD. There was no difference in estimated intraoperative blood loss, volume of intraoperative blood transfused, time to first flatus, time to off-bed activity, and postoperative hospital stay between the two groups. VLSD was associated with a shorter operation time (
P
= 0.020) and less postoperative complications (
P
< 0.0001), including less diarrhea (
P
< 0.0001), epigastric fullness (
P
< 0.0001), and delayed gastric emptying (
P
< 0.0001), compared with CLSD. With VLSD, there was a significant increase in body weight and plasma albumin levels at 6 months postoperatively compared with preoperative values (all
P
< 0.05). The curative effect of improving esophageal/gastric variceal bleeding was similar in the groups.
Conclusions
VLSD is effective and safe for reducing the incidence of postoperative complications, contributing to improving postoperative quality of life. |
---|---|
AbstractList | BackgroundConventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to the vagal nerve. We have developed vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection (VLSD). This study aimed to evaluate whether VLSD is effective and safe, and to determine whether a reduction in the incidence of postoperative complications improves postoperative quality of life compared with CLSD.MethodsWe retrospectively evaluated outcomes in 72 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism who underwent CLSD (n = 40) or VLSD (n = 32) between April 2015 and December 2016. Their demographic, intraoperative, and postoperative variables were compared.ResultsNo patients required conversion to laparotomy in CLSD and VLSD. There was no difference in estimated intraoperative blood loss, volume of intraoperative blood transfused, time to first flatus, time to off-bed activity, and postoperative hospital stay between the two groups. VLSD was associated with a shorter operation time (P = 0.020) and less postoperative complications (P < 0.0001), including less diarrhea (P < 0.0001), epigastric fullness (P < 0.0001), and delayed gastric emptying (P < 0.0001), compared with CLSD. With VLSD, there was a significant increase in body weight and plasma albumin levels at 6 months postoperatively compared with preoperative values (all P < 0.05). The curative effect of improving esophageal/gastric variceal bleeding was similar in the groups.ConclusionsVLSD is effective and safe for reducing the incidence of postoperative complications, contributing to improving postoperative quality of life. Conventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to the vagal nerve. We have developed vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection (VLSD). This study aimed to evaluate whether VLSD is effective and safe, and to determine whether a reduction in the incidence of postoperative complications improves postoperative quality of life compared with CLSD. We retrospectively evaluated outcomes in 72 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism who underwent CLSD (n = 40) or VLSD (n = 32) between April 2015 and December 2016. Their demographic, intraoperative, and postoperative variables were compared. No patients required conversion to laparotomy in CLSD and VLSD. There was no difference in estimated intraoperative blood loss, volume of intraoperative blood transfused, time to first flatus, time to off-bed activity, and postoperative hospital stay between the two groups. VLSD was associated with a shorter operation time (P = 0.020) and less postoperative complications (P < 0.0001), including less diarrhea (P < 0.0001), epigastric fullness (P < 0.0001), and delayed gastric emptying (P < 0.0001), compared with CLSD. With VLSD, there was a significant increase in body weight and plasma albumin levels at 6 months postoperatively compared with preoperative values (all P < 0.05). The curative effect of improving esophageal/gastric variceal bleeding was similar in the groups. VLSD is effective and safe for reducing the incidence of postoperative complications, contributing to improving postoperative quality of life. Background Conventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to the vagal nerve. We have developed vagus nerve-preserving laparoscopic splenectomy and azygoportal disconnection (VLSD). This study aimed to evaluate whether VLSD is effective and safe, and to determine whether a reduction in the incidence of postoperative complications improves postoperative quality of life compared with CLSD. Methods We retrospectively evaluated outcomes in 72 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism who underwent CLSD ( n = 40) or VLSD ( n = 32) between April 2015 and December 2016. Their demographic, intraoperative, and postoperative variables were compared. Results No patients required conversion to laparotomy in CLSD and VLSD. There was no difference in estimated intraoperative blood loss, volume of intraoperative blood transfused, time to first flatus, time to off-bed activity, and postoperative hospital stay between the two groups. VLSD was associated with a shorter operation time ( P = 0.020) and less postoperative complications ( P < 0.0001), including less diarrhea ( P < 0.0001), epigastric fullness ( P < 0.0001), and delayed gastric emptying ( P < 0.0001), compared with CLSD. With VLSD, there was a significant increase in body weight and plasma albumin levels at 6 months postoperatively compared with preoperative values (all P < 0.05). The curative effect of improving esophageal/gastric variceal bleeding was similar in the groups. Conclusions VLSD is effective and safe for reducing the incidence of postoperative complications, contributing to improving postoperative quality of life. |
Author | Qian, Jian-Jun Bai, Dou-Sheng Chen, Ping Jiang, Guo-Qing Jin, Sheng-Jie |
Author_xml | – sequence: 1 givenname: Dou-Sheng surname: Bai fullname: Bai, Dou-Sheng organization: Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University – sequence: 2 givenname: Ping surname: Chen fullname: Chen, Ping organization: Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University – sequence: 3 givenname: Sheng-Jie surname: Jin fullname: Jin, Sheng-Jie organization: Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University – sequence: 4 givenname: Jian-Jun surname: Qian fullname: Qian, Jian-Jun organization: Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University – sequence: 5 givenname: Guo-Qing orcidid: 0000-0002-8699-6624 surname: Jiang fullname: Jiang, Guo-Qing email: jgqing2003@hotmail.com organization: Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29101567$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_1007_s00464_022_09159_0 crossref_primary_10_1007_s00464_020_07573_w crossref_primary_10_1136_bmjopen_2019_030960 crossref_primary_10_2147_JHC_S425814 crossref_primary_10_1007_s00464_023_10454_7 crossref_primary_10_1007_s11605_021_05024_y |
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Keywords | Delayed gastric emptying Laparoscopy Vagus nerve Liver cirrhosis Portal hypertension |
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Conventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to... Conventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to the vagal... BackgroundConventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to... BACKGROUNDConventional open and conventional laparoscopic splenectomy and azygoportal disconnection (CLSD) result in poor quality of life because of damage to... |
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SubjectTerms | Abdominal Surgery Gastroenterology Gynecology Hepatology Laparoscopy Liver cirrhosis Medicine Medicine & Public Health Proctology Quality of life Surgery |
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Title | Vagus nerve-preserving versus conventional laparoscopic splenectomy and azygoportal disconnection |
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