Letter to the Editor: Serendipity during Sleeve Gastrectomy—Blood Supply Might Be Fundamental for Hunger and Satiety

Excerpt

Neural networks that regulate body weight and energy metabolism are rooted in the hypothalamus of the midbrain and the long-term regulation of body weight is well beyond our conscious control [1]. Nervous and endocrine signals are fundamental for the regulation of hunger and satiety [2], and gut hormones are responsible for a wide variety of physiologic and homeostatic mechanisms, including glycemic control, appetite stimulation, and suppression and regulation of gastric emptying [3]. Metabolic bariatric procedures cause a change in gut hormones which interact with the hypothalamus [4], and restrictive and malabsorptive procedures have shown to be the only evidence-based and long-term treatment option for severe obesity. Blood supply might also have an important impact, since left gastric artery embolization seems to reduce the supply of blood to the gastric fundus and decrease serum levels of ghrelin. Blood vessels are fundamental to transport and exchange the gut hormones and it seems that this alteration in gut hormone balance leads to changes in energy homeostasis and weight reduction [5, 6]. Nevertheless, left gastric artery embolization is an investigate procedure, and transient superficial mucosal ulcers are a common complication, and major adverse events include severe pancreatitis, splenic infarct, and gastric perforation [5]. The impact of simple skeletonizing of the greater curvature of the stomach has never been studied and the outcome of an incidental finding of esophageal leiomyoma identified during sleeve gastrectomy was thought-provoking in my clinical practice. …