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Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Thorax Left recurrent laryngeal nerveInferior cardiac plexusPulmonary plexusOesophageal plexusAnterior vagal trunk (LVN)Posterior vagal trunk (RVN)
Laparoscopic large hiatus hernia repair
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Alex Nagle, Geoffrey S. Chow, Nathaniel J. Soper
If there is less than 2.5 cm of esophagus below the crura, the mediastinal esophagus is mobilized further cephalad to gain additional length. During this dissection, the posterior vagal trunk is used as a landmark while bluntly mobilizing the esophagus anteriorly away from the spine and aorta, leav- ing the posterior vagal trunk attached to the posterior wall of the esophagus. This circumferential dissection can be taken to the level of the inferior pulmonary veins and is success- ful in achieving the desired intra-abdominal segment in the majority of cases. However, even after meticulous dissection, in 3%-14% of cases, the EGJ remains close to or above the crura, resulting in a “short esophagus.” Preoperative risk factors that predispose to the occurrence of short esophagus include long-standing gastroesophageal reflux or reopera- tion, an EGJ that is greater than 5 cm above the hiatus on esophagram or manometry, or the presence of peptic stric- tures or Barrett esophagus on endoscopy. However, even when taken in combination, these risk factors do a poor job of predicting which patients will ultimately require esopha- geal lengthening, and the final diagnosis is always made intraoperatively after a complete esophageal mobilization has been performed.
Abdomen
Published in David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings, McMinn’s Concise Human Anatomy, 2017
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings
Vagus nerves - entering the abdomen along the oesophagus as the anterior and posterior vagal trunks lying along the lesser curvature of the stomach in the lesser omentum, from which branches pass to the body of the stomach (to stimulate acid secretion) and to the gallbladder.
Systematic review on gastric electrical stimulation in obesity treatment
Published in Expert Review of Medical Devices, 2019
Alimujiang Maisiyiti, Jiande Dz Chen
Although vagal nerve stimulation does not belong to gastric electrical stimulation, it is included in this review as this is the only FDA approved implantable device for treating obesity. The device is called Maestro Rechargeable System or vBLOC implying the block of vagal nerve. It consists of two implantable parts: two leads that are placed around the anterior and posterior vagal trunks near the esophagogastric junction by laparoscopic surgery and a rechargeable pulse generator implanted subcutaneously on the thoracic wall [38,39]. The implantable pulse generator requires wireless charging approximately two times weekly. In the ReCharge Trial, which was a prospective, randomized, controlled trial, vBLOC showed clinically significant weight loss and improvements in obesity-related cardiovascular risk factors, healthy eating behaviors, and quality of life through 2 years follow-up [40]. A total of 239 patients with a BMI between 35 and 45 kg/m2 were randomized to vBLOC and sham control group in 2:1 ratio. The subcutaneous neuroregulator was implanted in the sham control group without any connected electrodes. All devices were programmed to deliver charges for at least 12 h a day. Mean %EWL was 24.4% for the vBLOC group and 15.9% for the sham group at 12 months. After 24 months, 76% of vBLOC participants were remained in the trial and had a mean %EWL of 21% [40,41].