Transient postsurgical gastroparesis is accompanied by reversible changes of the cervical vagus nerve's morphology after neck dissection - An ultrasound study

Abstract

Aims: During neck dissection (ND), the vagus nerve (VN) may be exposed to manipulation together with common carotid artery and internal jugular vein. The postsurgical gastroparesis was previous related to the VN injury. The aim of our study was to evaluate by ultrasound the VN changes in patients with unilateral and bilateral ND and to establish if there is a relationship between postoperative findings of VN and postsurgical gastroparesis. Material and methods: Seventeen patients in which 30 ND (4 unilateral and 13 bilateral) were performed, were enrolled in the study. The VN’s area and diameter were measured preoperative (baseline), one week (T1) and one month (T2) postoperative. Gastrointestinal symptoms were evaluated at T1 and T2 phases using the patient assessment of the upper gastrointestinal symptom severity index (PAGI-SYM). Results: There was a statistical difference between area and diameters of VN between T1 and baseline (p<0.001), and T1 and T2 phases (p<0.001), respectively. No statistical differences were detected at baseline and T2 phases in areas (p=0.934) and diameters (p>0.999). Gastrointestinal symptoms, found at the T1 phase regressed at T2 phase, were correlated with VN area and diameter changes (p<0.001). Conclusions: VN ultrasound clearly showed the transient dimensional changes of VN caused by manipulation in ND, which may lead to temporary gastrointestinal symptoms due to reversible dysfunction of VN. © 2020 Societatea Romana de Ultrasonografie in Medicina si Biologie. All rights reserved.