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Purpose: Evidences about the gut microbiota role in weight loss after bariatric surgery (BS) are growing. The objective of this study was to observe the changes of gut microbiota after sleeve gastrectomy (SG) and SG plus truncal vagotomy (SG-TV) and identify specific microbes that may contribute to the improvement of obesity after surgeries. Materials and Methods: Forty high-fat diet-induced obesity (DIO) mice were randomized to SG, SG-TV, or sham operation (SH) groups. Body weight (BW) and fast blood glucose (FBG) were measured before and 1, 2, 4, 8, and 12 weeks post-operatively. Fecal samples were collected before and at post-operative week 12 and profiled using 16S rRNA relative and absolute quantitative sequencing. Results: After the surgery, the SG and SG-TV surgeries significantly reduce BW and FBG levels compared with SH, and the SG-TV achieved better effects than SG. A decreasing trend in alpha diversity of gut microbiota and significant changes in taxonomic composition were observed after surgeries. Then, we identified a set of microbes and pathways significantly different in abundance after BS. The genus Parabacteroides and one pathway (polyketide sugar unit biosynthesis) increased in SG-TV group specially, which was also negatively correlated with BW and FBG. Conclusion: SG and SG-TV indeed achieve effects of weight loss, but TV could enhance the efficacy of SG. The identified different microbes and pathways, like Parabacteroides, polyketide sugar unit biosynthesis, may partly mediate the beneficial effects of BS, and thus possibly contribute to the development of novel bacteria-based therapeutic approaches. [ABSTRACT FROM AUTHOR]

Abstract Background We encountered a case of marginal ulcer in the jejunum after distal gastrectomy with jejunal pouch interposition. However, it has not been reported and not confirmed the treatment. We chose truncal vagotomy, considering reduced morbidity and postoperative complications. Case presentation A case was a 69-year-old woman who was admitted to our hospital with melena. She had received curative distal gastrectomy with a 15-cm jejunal pouch reconstruction for early gastric cancer. Marginal ulcer in the jejunal pouch was detected by upper gastrointestinal endoscopy. She was given medication; however, she repeated hospitalization for melena and abdominal pain. Therefore, we decided to perform surgery, and truncal vagotomy was performed. The patient’s postoperative course was uneventful and was discharged on the 22nd postoperative day. Symptoms such as abdominal pain and melena were improved after truncal vagotomy. Conclusion We presented a case with a complicated peptic ulcer after distal gastrectomy with reconstruction by jejunal pouch interposition, which was successfully treated by truncal vagotomy, a surgical acid-reducing procedure which does not require resection of remnant stomach.

Introduction: You are sitting for your oral surgery board exam and the examiner asks what you do when you realize that you have accidentally cut the posterior vagus nerve during a hiatal hernia repair. Is the answer to proceed with a gastric drainage procedure correct? The prevailing dogma seems to be that inadvertent vagotomy will produce gastric stasis/paresis and the stomach will not empty and hence should be accompanied by a gastric drainage procedure. This report presents clinical outcomes of 49 patients who underwent truncal vagotomy without a drainage procedure (pyloroplasty or gastrojejunostomy). Methods: 49 patients underwent truncal vagotomy with laparoscopic adjustable gastric banding in an IRB (Investigational Review Board)-approved clinical trial to determine if the addition of a vagotomy would increase achieved weight loss when compared to gastric banding alone. The details of this trial were presented at SAGES (Martin and Earle in Surg Endosc 25:2522–2525, 2011) in 2010. The patients in this study have been followed for over ten years and their histories were examined to look for evidence of gastric stasis or intractable diarrhea or if they required further surgery for these complaints. Results: 49 patients have been followed for a mean of 10.9 years. All except one have experienced a loss of hunger and cessation of gastric borborygmus. One patient showed mild delayed gastric emptying after developing diabetes. Two other patients with DM carry a diagnosis of gastroparesis. No patient has experienced intractable diarrhea. Five patients have had revisions to sleeve gastrectomy or gastric bypass for weight loss failure or esophageal dilatation and GERD. Conclusions: Review of these truncal vagotomy patients without drainage procedures at 10 years does not support the myth that the stomach will not empty after vagotomy and a gastric drainage procedure should always accompany truncal vagotomy. [ABSTRACT FROM AUTHOR]

Background: We encountered a case of marginal ulcer in the jejunum after distal gastrectomy with jejunal pouch interposition. However, it has not been reported and not confirmed the treatment. We chose truncal vagotomy, considering reduced morbidity and postoperative complications. Case presentation: A case was a 69-year-old woman who was admitted to our hospital with melena. She had received curative distal gastrectomy with a 15-cm jejunal pouch reconstruction for early gastric cancer. Marginal ulcer in the jejunal pouch was detected by upper gastrointestinal endoscopy. She was given medication; however, she repeated hospitalization for melena and abdominal pain. Therefore, we decided to perform surgery, and truncal vagotomy was performed. The patient's postoperative course was uneventful and was discharged on the 22nd postoperative day. Symptoms such as abdominal pain and melena were improved after truncal vagotomy. Conclusion: We presented a case with a complicated peptic ulcer after distal gastrectomy with reconstruction by jejunal pouch interposition, which was successfully treated by truncal vagotomy, a surgical acid-reducing procedure which does not require resection of remnant stomach. [ABSTRACT FROM AUTHOR]

Objective: To present a simple method of truncal vagotomy procedure, especially for the posterior vagal trunk, for standard definitive treatment of chronic duodenal ulcer perforation, in operable patients with suspected low compliance to receive a complete course of postoperative Helicobacter pylori eradication. Material and methods: A retrospective review of patients who underwent truncal vagotomy and pyroloplasty versus simple closure of perforation site for chronic duodenal ulcer perforation between September 2012 and June 2017. Clinical characteristics and surgical outcomes of patients, and details of surgical techniques for easy posterior truncal vagotomy were described. Result: There were 28 chronic duodenal ulcer perforation patients in this study. Sixteen patients underwent simple closure perforation site with non-absorbable suture. Twelve patients underwent truncal vagotomy and modified Heineke-Mikulicz pyloroplasty. The ASA functional classification, co-morbid diseases and baseline characteristic of patients between both groups were similar. The operative time was also not significantly different between operations. There was no morbidity and mortality at the 30 days of follow up. Conclusion: Simple posterior truncal vagotomy can be done safely with similar operative time as for simple closure in patients with perforated chronic duodenal ulcer. [ABSTRACT FROM AUTHOR]

Background Marginal ulcer (MU) is not infrequent after laparoscopic Roux-en-Y gastric bypass (LRYGB). Medication plus lifestyle modification remains the mainstay solution. Patients with refractory MU may be candidates for revisional surgery. Objective To summarize our experience of revisional surgery for treating refractory MU after LRYGB. Setting University hospital, Taiwan. Methods A retrospective analysis was performed for 11 patients with refractory MU undergoing totally hand-sewn gastrojejunostomy and truncal vagotomy at our institution between August 2005 and May 2015. The mean follow-up after surgery was 28.0±16.2 months (range, 10–48 mo); 9 patients (81.8%) were followed up more than 1 year after. Results The mean age of the cohort (7 males; 4 females) was 39.5±16.0 years (range, 19–66 yr), with a mean initial body mass index of 37.5±9.3 kg/m 2 (range, 32.1–57 kg/m 2 ). Intractability was the dominant manifestation (100%); 8 patients (72%) had stricture at the gastrojejunostomy. The mean interval from initial LRYGB to refractory MU and revisional surgery was 10.2±7.7 months (range, 4–28 mo) and 38.7±21.6 months (range, 10–67 mo), respectively. The average operation time was 150.4±59.8 minutes (range, 80–300 min), and the average length of hospital stay was 4.2±1.4 days (range, 2–7 d). The 9 patients with more than 1 year follow-up all achieved endoscopic resolution of the refractory MU. Conclusions Although longer follow-up is warranted, revisional surgery with totally hand-sewn gastrojejunostomy and truncal vagotomy can be an effective solution for refractory MU. [ABSTRACT FROM AUTHOR]

Background The incidence of gastric stump carcinoma (GSC) is not declining because of the long latency period. The survival rate of treated gastric cancer patients has increased due to early detection and improvements in surgical techniques and chemotherapy. Increased survival rates and improved surveillance following gastric surgery have increased the incidence of GSC. Aim The study aims to investigate the clinicopathological factors affecting the interval between index gastric surgery and the occurrence of GSC, and our experience in the management of GSC is presented. Methods A retrospective review of patients diagnosed with GSC in our institution was completed. Patient characteristics and clinicopathological outcomes were analyzed. Results A total of 28 patients were included in this cohort with 17 (60.71%) males and 11 (39.28%) females. The mean interval from index surgery to the incidence of GSC was 24.42 years for benign etiology and six years for malignant etiology. Index surgeries were truncal vagotomy with 14 gastrojejunostomies (50%) and 14 subtotal gastrectomies (50%). The interval between index surgery and the incidence of GSC is not statistically significant concerning the type of surgery (p: 0.661), pathological TNM (tumor, nodes, metastases) stage (p: 0.520), pathological differentiation (p: 0.828), lymphovascular invasion (p: 0.252), perineural invasion (p: 0.672), and adjuvant therapy (p: -0.655). Survival was significantly higher in those patients who received curative resection in comparison to a palliative procedure (p: 0.041). Conclusion Strict surveillance for at least 10 years after initial gastric surgery is of utmost importance as half of the patients fated to develop GSC will do so within this time. In those patients with early diagnosis, no evidence of metastasis, and good performance status, curative surgery is feasible with acceptable morbidity., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sangu et al.)