Vagal Nerve Division during Gastric Pouch Creation May Improve Outcome
Abstracts
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While performing a laparoscopic Roux-en-Y gastric bypass, division of the nerves of Laterjet often occurs during formation of the gastric pouch. This can be avoided by performing the more technically challenging lesser curvature dissection. We attempt to compare the gastrointestinal sequelae of these two approaches. Charts of those patients undergoing a laparoscopic Roux-en-Y gastric bypass at the University of Pittsburgh Health System between June 1999 and February 2001 were reviewed . All patients had a GIA stapled anastomosis over a 30 - 34 French stent. The Roux limb was varied according to body mass index (BMI). Group A underwent pouch creation with lesser curvature dissection using the harmonic scalpel. Group B underwent pouch creation with direct entry into the lesser sac with incision of the gastrohepatic ligament. 175 Patients were identified, 91 patients in group A, 84 patients in Group B. BMI was slightly higher in Group B (44 versus 41). (P=<.05) We observed the following: Strictures A = 3, B = 2, leaks A = 1, B = 0, diarrhea A = 2, B = 3, Gastric reminant leak A = 0, B = 0, clinically-significant gastric reminant distention A = 0, B = 0, marginal ulcer A = 4, B = 1. We conclude that there is very little sequela to division of the nerves of Laterjet during a laparoscopic Roux-en-Y gastric bypass except for a lower incidence of marginal ulcereration. |
