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Herein, we investigated whether subdiaphragmatic vagotomy has benefits on obesity, body glucose homeostasis, and insulin secretion in cafeteria (CAF)-obese rats. Wistar rats were fed a standard or CAF diet for 12 weeks. Subsequently, CAF rats were randomly submitted to truncal vagotomy (CAF Vag) or sham operation (CAF Sham). CAF Sham rats were hyperphagic, obese, and presented metabolic disturbances, including hyperinsulinemia, glucose intolerance, insulin resistance, hyperglycemia, and hypertriglyceridemia. Twelve weeks after vagotomy, CAF Vag rats presented reductions in body weight and perigonadal fat stores. Vagotomy did not modify glucose tolerance but normalized fed glycemia, insulinemia, and insulin sensitivity. Isolated islets from CAF Sham rats secreted more insulin in response to the cholinergic agent, carbachol, and when intracellular cyclic adenine monophosphate (cAMP) is enhanced by forskolin or 3-isobutyl-1-methylxanthine. Vagotomy decreased glucose-induced insulin release due to a reduction in the cholinergic action on β-cells. This effect also normalized islet secretion in response to cAMP. Therefore, vagotomy in rats fed on a CAF-style diet effectively decreases adiposity and restores insulin sensitivity. These effects were mainly associated with the lack of cholinergic action on the endocrine pancreas, which decreases insulinemia and may gradually reduce fat storage and improve insulin sensitivity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Given the rise of medical treatment for peptic ulcer disease (PUD), surgical treatment is necessary only in select cases and emergencies. The authors assess the current relevance of surgical vagotomy to treat PUD and its complications. DATA SOURCES: Although historically significant, selective and highly selective vagotomy is very technically challenging, and highly selective vagotomy has a relatively narrow indication and high recurrence rates. Vagotomy and gastrectomy is associated with significant side effects. Two types of vagotomy remain relevant, within a narrow scope. Truncal vagotomy and pyloroplasty is safe and efficacious through a laparoscopic approach in certain emergent cases. Vagotomy and Roux-en-Y gastrojejunostomy can be used to treat severe PUD refractory to medical management. CONCLUSIONS: The role of vagotomy in the management of PUD has a rich history but predated pharmacologic control of acid and understanding of the role of Helicobacter pylori in the disease. Thus, the current role of vagotomy is significantly limited. Specifically, the emergent use of truncal vagotomy is warranted for patients who are either resistant or allergic to proton pump inhibitors. [ABSTRACT FROM AUTHOR]

It was long believed that there were major differences in the pathophysiology between the three major categories of peptic ulcers. The unifying feature was that all peptic ulcers occurred in a mucosal compartment exposed to acid-pepsin secretions. All ulcers tended to heal more rapidly when acid secretion was more readily neutralized or inhibited. Decreased local resistance was considered to be present in primarily acute and chronic gastric ulcer. Surgery for peptic ulcer intended to reduce acid secretion, which also resulted in a diminished pepsin enzyme activity. The corresponding reduction could be accomplished either by gastric resection, different vagotomies or a combination of resections and vagotomies. Most of the procedures were basically abandoned at the time of introduction of modern medical therapeutic strategies. For duodenal ulcer and prepyloric ulcer diseases, various vagotomies were generally recommended or combined with antrectomy. Partial gastrectomy or antrectomy with gastroduodenostomy was the standard procedure for treatment of type 1 gastric ulcer. The great caveat associated with surgical procedures for elective treatment of uncomplicated peptic ulcer disease is confined to operative mortality, postoperative morbidity, and late postoperative metabolic sequelae. The only remaining indication today of remedial gastric surgery for peptic ulcer disease is when there is a defined risk for gastric cancer in an unhealed gastric ulcer and very seldom in a case with recurrent or therapy-resistant peripyloric ulcer. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The following on surgical treatments for Barrett's esophagus includes commentaries on the indications for antireflux surgery after medical treatment; the effects of the various procedures on the lower esophageal sphincter; the role of impaired esophageal motility and delayed gastric emptying in the choice of the surgical procedure; indications for associated highly selective vagotomy, duodenal switch, and gastric electrical stimulation; therapeutic strategies for detection and treatment of shortened esophagus; the role of antireflux surgery on the regression of metaplastic mucosa and the risk of malignant progression; the detection of asymptomatic reflux brfore bariatric surgery; the role of non-GERD symptoms on the results of surgery; and the indications of Collis gastroplasty and choice of the type of fundoplication. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic adjustable gastric banding (LAGB) causes weight loss primarily through a mechanical restrictive mechanism. The vagus nerve provides connections between the brain and the gut through afferent and hormonal signals that regulate fullness and satiety. Published studies demonstrate clinically significant weight loss by subjects undergoing open surgical truncal vagotomy for ulcer disease and morbid obesity. This study aimed primarily to evaluate the safety and efficacy of adding truncal vagotomy to LAGB and to compare the weight loss with that of LAGB alone. Methods: This open-label case-controlled study was conducted at Central Carolina Surgery, PA, a private bariatric surgery practice in Greensboro, North Carolina. Since May 2006, 49 subjects with classes 2 and 3 obesity have undergone LAGB with truncal vagotomy. The anterior and posterior nerves were divided and resected just below the diaphragm and sent to pathology. The primary safety variable was the number of procedure-related adverse events. The primary efficacy variable was the percentage of excess weight loss (%EWL). Completeness of vagotomy was assessed by direct inspection, microscopic confirmation, and endoscopic Congo red testing after intravenous Baclofen stimulation. For the ongoing comparison, 49 cohorts were matched for age, sex, and preoperative body mass index (BMI). Results: At enrollment, the average BMI was 45 kg/m, and the average age was 46 years. No intraoperative or unanticipated adverse events occurred. All the subjects were discharged in 24 h less. One case of incomplete vagotomy was confirmed via pathologic evaluation. The LAGB plus vagotomy group had an average EWL of 38% at an mean of 34 months after surgery, and the cohort group had an average EWL of 36% at a mean of 36 months after surgery. All the vagotomy patients reported an absence of hunger. No diarrhea, no significant gastric outlet obstruction, and no dumping were seen. Conclusions: The study data do not support the hypothesis that vagotomy added to LAGB enhances weight loss. [ABSTRACT FROM AUTHOR]

Little is known about the advantages of laparoscopic truncal vagotomy with gastrojejunostomy (LTVGJ) over open truncal vagotomy with gastrojejunostomy (OTVGJ) for peptic pyloric stenosis (PPS). This study aimed to highlight the role of minimally invasive surgery in the form of LTVGJ for PPS. From March 1999 to October 2005, 21 patients with PPS underwent LTVGJ ( n = 13) and OTVGJ ( n = 8). We analyzed intraoperative and postoperative outcomes retrospectively. Two groups had similar demographic characteristics. Significantly shorter operating time, hospital stay, time to presence of bowel sounds, and time to tolerate a diet were the advantages of LTVGJ, while blood loss was higher in OTVGJ. There were significant differences in weight gain between the two groups after surgery during follow-up. This study suggests that LTVGJ is a feasible technique, and intermediate follow-up reveals good symptomatic results when used for PPS. [ABSTRACT FROM AUTHOR]

Background: We have documented previously diurnal rhythms in intestinal sugar transporter expression. We set out to identify the role of the vagus nerve in these rhythms. Materials and methods: Sprague–Dawley rats underwent truncal vagotomy (V; n = 9) and were pair-fed with sham-operated (n = 4) and unoperated rats (n = 6). Rats were killed at ZT3 and ZT9 (ZT: Zeitgeber time with ZT0 set at lights-on), the time interval over which sucrase, SGLT1, GLUT2, and GLUT5 expression exhibit significant anticipatory increases. Jejunal RNA expression for the four genes were assessed by Northern blot analysis. SGLT1 and GLUT2 expression was further studied by Western blot analysis and in situ hybridization. Results: Control rats (sham-operated plus unoperated rats) exhibited the expected increase in RNA levels at ZT9 versus ZT3 for SGLT1, GLUT2, GLUT5, and sucrase (P < 0.01 for each). The diurnal rhythm of mRNA levels for GLUT2 and sucrase, but not for SGLT1 or GLUT5, were blunted in V rats. At protein level, SGLT1 was induced 4.3-fold in control rats (P < 0.01) and 3.8-fold in V rats (P < 0.01), whereas GLUT2 was induced 3.3-fold in control rats (P < 0.01) but only 1.4-fold in V rats (N.S.). Conclusions: Our results indicate that signaling through the vagus nerve is necessary for the anticipatory induction of GLUT2 and sucrase. Persistence of normal rhythms in both SGLT1 and GLUT5 indicates that diurnal induction of these genes is independent of vagal innervation. Entrainment of anticipatory diurnal gene expression in the intestine occurs via two separate pathways that are differentially dependent on vagal input. [Copyright &y& Elsevier]

Truncal vagotomy enhances gallstone formation. As esophagectomy involves truncal vagotomy, it was hypothesized that esophagectomy would increase the risk of cholelithiasis. This study was intended to test this hypothesis and to elucidate factors influencing the incidence of cholelithiasis after esophagectomy. The study was a retrospective analysis of 136 patients with esophageal carcinoma who had survived for 5 years or longer after esophagectomy. Eight patients (5.9%) had cholelithiasis before esophagectomy. Of the remaining 128 patients, 113 underwent abdominal ultrasonographic examination for cholelithiasis twice a year after esophagectomy; the median follow-up time was 89.5 months (range, 60–117 months). Gallstones developed in 26 (23%) of the 113 patients undergoing regular ultrasonographic examination. The cumulative incidence of cholelithiasis reached a plateau of 34% at 10 years after esophagectomy. Reduction of body mass index after esophagectomy was the strongest independent predictor of gallstone formation after esophagectomy ( P = 0.0001, log-rank test; P = 0.0003, Cox’s proportional hazards model). The prevalence of cholelithiasis at 5 years after esophagectomy (18/113; 16%) was significantly higher than that before esophagectomy (8/136; 5.9%; P = 0.012, Fisher’s exact test). Esophagectomy yields an increased risk of the development of cholelithiasis. Truncal vagotomy and postsurgical malnutrition may contribute to this increased gallstone formation after esophagectomy. [ABSTRACT FROM AUTHOR]

Animal models are necessary for research, technical developments, and training purposes in laparoscopic surgery. Although various operations on small animals have been described, there is still a need for a simple and practical laparoscopic small animal model. We acknowledged truncal vagotomy as a simple procedure, and aimed to develop a model of laparoscopic truncal vagotomy (LTV) in the rat, an inexpensive and easily available animal. Fifty Wistar rats were randomized into an LTV group ( n= 25) and an open truncal vagotomy (OTV) group ( n= 25). LTV was effected with two minitrocars inserted into the left upper and right lower quadrants. Two techniques of vagotomy were developed: first, with the esophagus in its anatomical position, and second, with the distal esophagus retracted anteriorly with a grasper inserted into the retroesophageal space. OTV was performed through a midline incision. Animals were sacrificed 24 h post-operatively, and autopsy was performed. The mean ± SD operating time was 8.3 ± 1.4 min in the LTV group and 5.5 ± 0.2 min in the OTV group ( P < 0.05). The laparoscopically magnified view provided a better distinction of vagal fibers compared with open surgery, with the second laparoscopic technique providing the best exposure. Complications developed in three rats (12%) from the LTV group and one (4%) from the OTV group ( P > 0.05). Vagotomy was confirmed to be complete at autopsy in all of the animals. This is the first technical description of laparoscopic peptic ulcer surgery in the rat. Although subsequent histopathological and physiological studies may be required, technically, laparoscopic vagotomy in the rat seems to be a simple, inexpensive, and expeditious small-animal model for laparoscopic research. [ABSTRACT FROM AUTHOR]

Erythromycin has been found to be a gastrointestinal prokinetic agent while acute hyperglycemia has been associated with delayed gastric emptying in healthy controls and diabetics. The aim of this study was to investigate whether hyperglycemia, per se, alters gastric motility, during erythromycin-induced acceleration of gastric emptying of solids in patients with truncal vagotomy and pyloroplasty (TVP) and the role of vagus nerves. Eight TVP patients and six controls underwent scintigraphic measurement of gastric emptying of a solid meal, during placebo in normoglycemia (5–8.9 mmol/liter glucose) or 200 mg intravenous erythromycin lactobionate in normo- or hyperglycemia (16–19 mmol/liter glucose) induced by intravenous glucose infusion, on separate days in random order. In the TVP patients during normoglycemia, the erythromycin compared to placebo accelerated the meal gastric half-emptying time ( T $${\raise0.7ex\hbox{$1$} \!\mathord{\left/{\vphantom {1 2}}\right.\kern-\nulldelimiterspace}\!\lower0.7ex\hbox{$2$}}$$ ), (37.12 ± 6.87 vs 91.88 ± 11.53, P < 0.001) and decreased the lag-phase duration (P < 0.001) and the percentage of meal retained in the stomach at 120 min (P < 0.001). Erythromycin in hyperglycemia compared to normoglycemia increased T $${\raise0.7ex\hbox{$1$} \!\mathord{\left/ {\vphantom {1 2}}\right.\kern-\nulldelimiterspace}\!\lower0.7ex\hbox{$2$}}$$ (61.25 ± 10.67 vs 37.12 ± 6.87, P < 0.001), prolonged lag-phase duration (P < 0.001), and the percentage of isotope retained in the stomach at 120 min (P < 0.001). The T $${\raise0.7ex\hbox{$1$} \!\mathord{\left/ {\vphantom {1 2}}\right.\kern-\nulldelimiterspace}\!\lower0.7ex\hbox{$2$}}$$ , the lag phase duration, and the meal retained in the stomach at 120 min, after giving placebo was significantly increased, compared to erythromycin administration in hyperglycemia (P < 0.001). Significant differences among patients and controls were found during gastric emptying after giving placebo and after erythromycin in hyperglycemia (P = 0.04 and P = 0.007, respectively), while nonsignificant differences were found after giving erythromycin in normoglycemia. We conclude that the effect of erythromycin-induced acceleration on gastric emptying is related to the plasma glucose level. Hyperglycemia reduces the erythromycin-induced acceleration of gastric emptying of solids in both controls and TVP patients. A significant increase in the delay of gastric emptying was achieved in TVP patients compared to controls after giving erythromycin in hyperglycemia and after placebo. Despite the inhibitory effect of induced hyperglycemia on gastric emptying, erythromycin is still able to accelerate the emptying rate and could prove to be a useful prokinetic agent under hyperglycemic conditions. Hyperglycemia may indicate a cholinergic-antagonist pathway that delays the erythromycin-induced acceleration of gastric emptying of solids and is more evident in vagotomized patients than controls, who retain the functional integrity of the vagus nerves. [ABSTRACT FROM AUTHOR]

Ten dogs equipped with four bipolar silver needle electrodes and three strain gauges on the anterior wall of their stomachs underwent three types of vagotomy: truncal vagotomy (TV)-4 dogs; selective proximal vagotomy (SPV) 3 dogs; and antral vagotomy (AV)-3 dogs. Electrical and contractile activities of the stomach were examined before and after these vagotomies on both the fasting and postprandial states. TV caused an increased incidence of dysrhythmia and a 9% to 22% reduction of the propagatiom velocity of basic electrical rhythn (BER). Following feeding, the characteristic waxing and waning pattern of normal gastric contraction was altered to a monotonous steady pattern, increasing overall contraction activity of the pyloric sphincter. These changes seemed attributable to delayed gastric emptying following truncal vagotomy. SPV reduced the propagation velocity of BER slightly, preserving the inherent physiological contractile activity in the antrum and pyloric sphincter, and transforming the contractile activity in the corpus to a more monotonous steady pattern. AV effected a localized monotonous contractile activity in the antral region with no changes descernible in the body and pyloric sphincter. [ABSTRACT FROM AUTHOR]

Recently selective proximal vagotomy has been supplanting truncal vagotomy as a method of choice for peptic ulcers because of its effectiveness in lowering gastric acidity while lessening pyloric spasm. However, its postoperative consequence has not been fully investigated. In the present communication, lithogenic tendency of bile after selective proximal vagotomy has been studied using solubility of human gallstone inserted in dog gallbladder and change in bile composition. The result indicated that after selective proximal vagotomy gallstone incidence is not likely to increase which has been one of the major drawbacks of truncal vagotomy. [ABSTRACT FROM AUTHOR]

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The fine structural alteration in the gastric nerve fibers containing gastrin-releasing peptide (GRP) was studied in relation to the dynamics of gastrin-producing cells (G-cells) after truncal vagotomy in a rat model. The circulating gastrin levels were markedly elevated from the 1st day after vagotomy and the number of G-cells with positive immunoreaction for G17 and G34(1-15) was significantly increased in the vagotomized group. On the 3rd day after vagotomy, the G-cells showed conspicuous ultrastructural changes characterized by hypertrophy of the Golgi complexes and increased numbers of secretory granules. The GRP-positive nerve fibers formed a fine network in the gastric wall and were densely distributed in the oxyntic mucosa close to the blood vessels and showing varicosites composed of either small clear or GRP-positive large vesicles containing an electron-dense core. In the oxyntic mucosa of the vagotomized rats, axonal swelling of the nerves occurred on the 3rd day, and a depletion of GRP immunoreactivity was evidenced by a markedly decreased number of large-cored vesicles on the 7th day, when the serum GRP levels were also found to be markedly elevated. These findings indicate that the alteration in gastric nerve fibers containing GRP after truncal vagotomy may be related to hypergastrinemia and antral G-cell hyperplasia in the rat gastric mucosa. [ABSTRACT FROM AUTHOR]

The kinetics of somatostatin-producing cells (D-cells) in the rat antral mucosa after truncal vagotomy were studied using double immunostaining for bromodeoxyuridine (BrdU) and somatostatin. Both the concentration of somatostatin and D-cell density in the antral mucosa demonstrated a significant increase on the 3rd day after truncal vagotomy. With the single labeling of BrdU, a few D-cells showed positive immunostaining for BrdU throughout the experimental period in both vagotomized and sham operated rats. With cumulative labeling, the BrdU labeled cells demonstrated a linear increase in an identical number for each experimental time-point in both groups. The labeling index of BrdU in the D-cells increased significantly, beginning on the 3rd day and attaining a maximum level of 41.8% on the 10th day, in the vagotomized group after cumulative labeling. In this group, however, the density of D-cells with no immunoreactive BrdU also increased quickly on the 3rd day with cumulative labeling. The present study indicates that the most important factor involving D-cell hyperplasia observed after truncal vagotomy is the activation of pre-existing D-cells to synthesize and release hormones, together with the rapid replication of progenitor cells and their maturation to D-cells. [ABSTRACT FROM AUTHOR]