Division of GI/Minimally Invasive Surgery, Department of Surgery, Loyola University Chicago Stritch School of Medicine, 2160 South First Avenue, Maywood, IL, 60153, USA.
Department of Surgery, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand.
Surg Endosc. 2019 Aug;33(8):2620-2628. doi: 10.1007/s00464-018-6562-9. Epub 2018 Oct 25.
Thoracic and foregut operations can cause vagal nerve injury resulting in delayed gastric emptying or gastroparesis. However, the cause of gastroparesis in these patients is not always from a vagal injury. We hypothesize that vagal nerve integrity (VNI) testing may better define who has vagal nerve dysfunction. This information may change subsequent operations. The aim of this study was to evaluate the impact of VNI testing in patients with prior thoracic or gastric surgery.
From January 2014 to December 2017, patients who had previous operations with the potential risk of vagal injury and had VNI testing were reviewed. Excluded patients were those with no plan for a second operation or the second operation was only for gastroparesis. The main outcome was the percentage of operations altered due to the results of VNI testing.
Twelve patients (eight females) were included. Ages ranged from 37 to 77 years. VNI results were compatible with vagal injury in eight patients (67%). VNI test results altered subsequent operative plans in 41.7% (5/12). Pyloroplasty was done in addition to fundoplication in two patients. Plans for hiatal hernia repair with or without redo-fundoplication in three patients were changed by an additional pyloroplasty in one patient and partial gastrectomy with Roux-en-Y reconstruction in two patients. All patients who had secondary surgery had resolution of symptoms and improvement in objective testing.
The addition of VNI testing in patients with a previous potential risk of vagal nerve injury may help the surgeon select the appropriate secondary operation.
胸和前肠手术可导致迷走神经损伤，导致胃排空延迟或胃轻瘫。然而，这些患者胃轻瘫的原因并不总是来自于迷走神经损伤。我们假设迷走神经完整性（VNI）测试可以更好地定义谁存在迷走神经功能障碍。这些信息可能会改变后续的手术。本研究的目的是评估 VNI 测试在前胸或胃部手术后患者中的影响。
从 2014 年 1 月至 2017 年 12 月，对有潜在迷走神经损伤风险且进行 VNI 测试的既往手术患者进行了回顾性分析。排除标准为：无第二次手术计划或第二次手术仅用于治疗胃轻瘫的患者。主要结果是由于 VNI 测试结果而改变的手术比例。
共纳入 12 例患者（8 例女性），年龄 37-77 岁。8 例（67%）患者的 VNI 结果提示迷走神经损伤。VNI 测试结果改变了 41.7%（5/12）患者的后续手术计划。2 例患者在胃底折叠术的基础上附加了幽门成形术。3 例患者的计划为食管裂孔疝修补术，其中 1 例患者因附加幽门成形术而改变为食管裂孔疝修补术联合胃底折叠术，2 例患者因附加部分胃切除术和 Roux-en-Y 重建术而改变为食管裂孔疝修补术联合胃底折叠术。所有接受二次手术的患者均症状缓解，客观检查改善。
在前有潜在迷走神经损伤风险的患者中增加 VNI 测试可能有助于外科医生选择合适的二次手术。
