Clinical Research
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 14, 2006; 12(14): 2209-2216
Published online Apr 14, 2006. doi: 10.3748/wjg.v12.i14.2209
Surgical anatomy of the innervation of pylorus in human and Suncus murinus, in relation to surgical technique for pylorus-preserving pancreaticoduodenectomy
Shuang-Qin Yi, Fei Ru, Tetsuo Ohta, Hayato Terayama, Munekazu Naito, Shogo Hayashi, Sichen Buhe, Nozomi Yi, Takayoshi Miyaki, Shigenori Tanaka, Masahiro Itoh
Shuang-Qin Yi, Hayato Terayama, Munekazu Naito, Shogo Hayashi, Sichen Buhe, Nozomi Yi, Takayoshi Miyaki, Masahiro Itoh, Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
Fei Ru, Department of Medicine, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, Maryland 21287, United States
Tetsuo Ohta, Department of Gastroenterologic Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa 920-8420, Japan
Shigenori Tanaka, Department of Anatomy and Neuroembryology, Kanazawa University, 13-1 Takara-Machi, Kanazawa 920-8420, Japan
Supported by Ministry of Education, Culture, Sports, Science and Technology of Japan Grant, No. 14570008
Correspondence to: Dr Shuang-Qin Yi, Department of Anatomy, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan. yixim@tokyo-med.ac.jp
Telephone: +81-3-33516141 Fax: +81-3-33411137
Received: September 23, 2005
Revised: October 15, 2005
Accepted: November 18, 2005
Published online: April 14, 2006
Abstract

AIM: To clarify the innervation of the antro-pyloric region in humans from a clinico-anatomical perspective.

METHODS: The stomach, duodenum and surrounding structures were dissected in 10 cadavers, and immersed in a 10mg/L solution of alizarin red S in ethanol to stain the peripheral nerves. The distribution details were studied to confirm innervations in the above areas using a binocular microscope. Similarly, innervations in 10 Suncus murinus were examined using the method of whole-mount immunohistochemistry.

RESULTS: The innervation of the pyloric region in humans involved three routes: One arose from the anterior hepatic plexus via the route of the suprapyloric/supraduodenal branch of the right gastric artery; the second arose from the anterior and posterior gastric divisions, and the third originated from the posterior-lower region of the pyloric region, which passed via the infrapyloric artery or retroduodenal branches and was related to the gastroduodenal artery and right gastroepiploic artery. For Suncus murinus, results similar to those in humans were observed.

CONCLUSION: There are three routes of innervation of the pyloric region in humans, wherein the route of the right gastric artery is most important for preserving pyloric region innervation. Function will be preserved by more than 80% by preserving the artery in pylorus-preserving pancreaticoduodenectomy (PPPD). However, the route of the infrapyloric artery should not be disregarded. This route is related to several arteries (the right gastroepiploic and gastroduodenal arteries), and the preserving of these arteries is advantageous for preserving pyloric innervation in PPPD. Concurrently, the nerves of Latarjat also play an important role in maintaining innervation of the antro-pyloric region in PPPD. This is why pyloric function is not damaged in some patients when the right gastric artery is dissected or damaged in PPPD.

Keywords: Innervation, Quality of life, Pylorus-preserving pancreaticoduodenectomy, Suncus murinus, Whole mount immunohistochemistry