Top

World Journal of Surgery

Published in:

01-06-2020 | Vagotomy | Original Scientific Report

Metabolic Effect of the Hepatic Branch of the Vagal Nerve in One-Anastomosis Gastric Bypass (OAGB)

Authors: Jaime Ruiz-Tovar, Carolina Llavero

Published in: World Journal of Surgery | Issue 6/2020

Abstract

Background

Bariatric surgery is often performed not only to lose weight, but also to improve obesity-related comorbidities. A certain metabolic effect of the bariatric techniques has been demonstrated, as the improvement or even remission of comorbidities is patent, before having lost a relevant amount of weight. The autonomic innervation of diverse viscera by the vagus nerve has been hypothesized to participate in it. We aimed to evaluate the ponderal and metabolic impact of the preservation of the hepatic branch of the vagus in type 2 diabetic (T2D) patients undergoing one-anastomosis gastric bypass (OAGB).

Patients and methods

We conducted a prospective study on patients with a preoperative diagnosis of morbid obesity and T2D, who underwent an OAGB. Preservation of the hepatic branch of the vagus was carried out in the first 14 patients (Group 1), whereas in another 14 patients it was sectioned. Ponderal and metabolic outcomes were assessed 1 and 2 years after surgery.

Results

The length of the biliary limb was 210 cm in both groups. Postoperative BMI or excess BMI loss was not significantly different between groups. The patients included in Group 1 showed a statistically greater improvement in glycemic and lipid variables.

Conclusion

The preservation of the hepatic branch of the vagus in an OAGB leads to more favorable postoperative glycemic and lipid profiles.

Health topics. Obesity. World Health Organization (WHO June 016). http://www.who.it

Melissas J, Stavroulakis K, Tzikoulis V et al (2017) Sleeve gastrectomy vs Roux-en-Y gastric bypass. Data from IFSO European chapter center of excellence program. Obes Surg 27:847–855CrossRef

Carbajo MA, Luque de Leon E, Jimenez JM et al (2017) Laparoscopic one-anastomosis gastric bypass: technique, results and long-term follow-up in 1200 patients. Obes Surg 27:1153–1167CrossRef

Shah M, Law JH, Micheletto F et al (2014) Contribution of endogenous glucagon-like peptide 1 to glucose metabolism after Roux-en-Y gastric bypass. Diabetes 63:483–493CrossRef

Lips MA, Groot GH, Klinken JB et al (2014) Calorie restriction is a major determinant of the short-term metabolic effects of gastric bypass surgery in obese type 2 diabetic patients. Clin Endocrinol 80:834–842CrossRef

Qiu NC, Liu ME, Wang B et al (2014) Does the hepatic branch of vagus mediate the secretion of glucagon-like peptide-1 during the Roux-en-Y gastric bypass surgery? J Gastrointest Surg 18:1957–1964CrossRef

Hayes MR, Kanoski SE, De Jonghe BC et al (2011) The common hepatic branch of the vagus is not required to mediate the glycemic and food intake suppressive effects of glucagon-like-peptide-1. Am J Physiol Regul Integr Comp Physiol 301:R1479CrossRef

Nishizawa M, Nakabayashi H, Uehara K et al (2013) Intraportal GLP-1 stimulates insulin secretion predominantly through the hepatoportal-pancreatic vagal reflex pathways. Am J Physiol Endocrinol Metab 305:E376–E387CrossRef

Rubio MA, Monereo S, Lecube A et al (2013) Joint position statement of the SEEN-SECO-SEEDO-SED societies on metabolic surgery for type 2 diabetes mellitus. Endocrinol Nutr 60:547–548CrossRef

10.

Flores L, Vidal J, Canivell S et al (2014) Hypertension remission 1 year after bariatric surgery: predictive factors. Surg Obes Relat Dis 10:661–665CrossRef

11.

Shin AC, Zheng H, Berthoud HR et al (2012) Vagal innervation of hepatic portal vein and liver is not necessary for Roux-en-Y gastric bypass surgery-induced hypophagia, weight loss, and hypermetabolism. Ann Surg 255:294–301CrossRef

12.

Lam TK, Pocai A, Gutierrez-Juarez R et al (2005) Hypothalamic sensing of circulating fatty acids is required for glucose homeostasis. Nat Med 11:320–327CrossRef

13.

Pocai A, Obici S, Schwartz GJ et al (2005) A brain-liver circuit regulates glucose homeostasis. Cell Metab 1:53–61CrossRef

14.

Tiscornia OM, Yacomotti J, Losardo RJ (2002) Investigation and conceptual revision of the gastro-duodeno-pancreatic innervation. Rev Chil Anat 20:1–6CrossRef

15.

Berthoud HR, Lynn PA, Blackshaw LA (2001) Vagal and spinal mechanosensors in the rat stomach and colon have multiple receptive fields. Am J Physiol 280:1371–1381

16.

Ballsmider LA, Vaughn AC, David M (2015) Sleeve gastrectomy and Roux-en-Y gastric bypass alter the gut-brain communication. Neural Plasticity 601985:1–9CrossRef

17.

Hira T, Mochida T, Miyashita K et al (2009) GLP-1 secretion is enhanced directly in the ileum but indirectly in the duodenum by a newly identified potent stimulator, zein hydrolysate, in rats. Am J Physiol Gastrointest Liver Physiol 297:G663–G671CrossRef

18.

Qiu NC, Zhang Q, Song X et al (2014) Impact of the hepatic branch of the vagus and Roux-en-Y gastric bypass on the hypoglycemic effect and glucagon-like peptide-1 in rats with type 2 diabetes mellitus. J Surg Res 1:e7

19.

Warne JP, Foster MT, Horneman HF et al (2008) The gastroduodenal branch of the common hepatic vagus regulates voluntary lard intake, fat deposition, and plasma metabolites in streptozotocin-diabetic rats. Am J Physiol Endocrinol Metab 294:E190CrossRef

20.

Gao X, van der Veen JN, Zhu L et al (2015) Vagus nerve contributes to the development of steatohepatitis and obesity in Phosphatidylethanolamine N-Methyltransferase deficient mice. J Hepatol 62:913–920CrossRef

21.

Berthoud HR (2008) The vagus nerve, food intake and obesity. Regul Pept 149:15–25CrossRef

22.

Katagiri H, Yamada T, Oka Y (2007) Adiposity and cardiovascular disorders: disturbance of the regulatory system consisting of humoral and neuronal signals. Circ Res 101:27–39CrossRef

23.

Imai J, Katagiri H, Yamada T et al (2008) Regulation of pancreatic beta cell mass by neuronal signals from the liver. Science 322:1250–1254CrossRef

24.

Uno K, Yamada T, Ishigaki Y et al (2012) Hepatic peroxisome proliferator-activated receptor-gamma-fat-specific protein 27 pathway contributes to obesity-related hypertension via afferent vagal signals. Eur Heart J 33:1279–1289CrossRef

25.

Bernal-Mizrachi C, Xiaozhong L, Yin L et al (2007) An afferent vagal nerve pathway links hepatic PPARalpha activation to glucocorticoid-induced insulin resistance and hypertension. Cell Metab 5:91–102CrossRef

26.

Scribner KA, Walker C-D, Cascio CS et al (1991) Chronic streptozotocin diabetes in rats facilitates the acute stress response without altering pituitary or adrenal responsiveness to secretagogues. Endocrinology 129:99–108CrossRef

27.

Chan O, Inouye K, Akirav E et al (2005) Insulin alone increases hypothalamo-pituitary-adrenal activity, and diabetes lowers peak stress responses. Endocrinology 146:1382–1390CrossRef

28.

Ruiz-Tovar J, Llavero C, Ortega I et al (2015) Percutaneous electric neurostimulation of dermatome T7 improves glycemic profile in obese and type 2 diabetic patients. A randomized clinical study. Cir Esp 93:460–465CrossRef

Title: Metabolic Effect of the Hepatic Branch of the Vagal Nerve in One-Anastomosis Gastric Bypass (OAGB)
Authors: Jaime Ruiz-Tovar
Carolina Llavero
Publication date: 01-06-2020
Publisher: Springer International Publishing
Keywords: Vagotomy
Insulins
Insulins
Published in: World Journal of Surgery / Issue 6/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05405-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Metabolic Effect of the Hepatic Branch of the Vagal Nerve in One-Anastomosis Gastric Bypass (OAGB)

Abstract

Background

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2020

Evaluation of the CT Scan as the First Examination for the Diagnosis and Therapeutic Strategy for Acute Cholecystitis

Adrenalectomy for Primary Aldosteronism: Significant Variability in Work-Up Strategies and Low Guideline Adherence in Worldwide Daily Clinical Practice

Invited Commentary on: Beta-Blocker Therapy in Severe Traumatic Brain Injury: A Prospective Randomized Controlled Trial

Impact of Hepatic Artery Variations and Reconstructions on the Outcome of Orthotopic Liver Transplantation

Short- and Long-Term Outcomes of Right-Sided Diverticulitis: Over 15 Years of North American Experience

The Obesity Paradox in the Trauma Patient: Normal May not Be Better