Published online Mar 16, 2023. doi: 10.12998/wjcc.v11.i8.1862
Peer-review started: January 7, 2023
First decision: January 17, 2023
Revised: January 19, 2023
Accepted: February 21, 2023
Article in press: February 21, 2023
Published online: March 16, 2023
Video-assisted thoracic surgery (VATS) lobectomy is a common treatment for patients with early-stage lung cancer. Some patients can experience slight gastrointestinal discomfort after lobectomy for a moment. Gastroparesis is a gastrointestinal disorder that can be severe; it is associated with an increased risk of aspiration pneumonia and impaired postoperative recovery. Here, we report a rare case of gastroparesis after VATS lobectomy.
A 61-year-old man underwent VATS right lower lobectomy uneventfully but had an obstruction of the upper digestive tract 2 d after surgery. Acute gastroparesis was diagnosed after emergency computed tomography and oral iohexol X-ray imaging. After gastrointestinal decompression and administration of prokinetic drugs, the patient’s gastrointestinal symptoms improved. Since perioperative medication was applied according to the recommended dose and there was no evidence of electrolyte imbalance, intraoperative periesophageal vagal nerve injury was the most likely underlying cause of gastroparesis.
Although gastroparesis is a rare perioperative complication following VATS, clinicians should be on the alert when patients complain about gastrointestinal discomfort. When surgeons resect paraesophageal lymph nodes with electrocautery, excessive ambient heat and compression of paraesophageal hematoma might induce vagal nerve dysfunction.
Core Tip: While postoperative gastroparesis is quite common in patients undergoing vagotomy for peptic ulcers and pylorus-sparing pancreatoduodenectomy, there are few reports following lobectomy. We report a rare case of gastroparesis after video-assisted thoracoscopic surgery. Since there was no evidence of drug-induced or electrocyte disorder-related gastrointestinal dysfunction, intraoperative periesophageal vagal nerve injury was most likely to account for gastroparesis. Clinicians should keep in mind that there is a potential possibility of vagal nerve injury after thoracic surgery even without direct nerve operation. For patients suffering gastroparesis after video-assisted thoracic surgery, conservative treatment, including gastrointestinal decompression and prokinetic medicines, can help relieve symptoms.