An improved technique for laparoscopic highly selective vagotomy using harmonic shears

Katkhouda, Namir; Waldrep, Donald J.; Campos, Guilherme M.; Tang, E.; Offerman, Steven R.; Trussler, Andrew P.; Gugenheim, Jean; Mouïel, J

doi:10.1007/s004649900779

Cited by 9 publications

(1 citation statement)

References 11 publications

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“…Introduction of laparoscopic approaches into routine surgical practice has substantially improved the safety of operating on severely obese patients, who are at increased risk of operative complications of any laparotomy. Laparoscopic truncal vagotomy has been perfected and proven safe and effective for ulcer disease [64]. For obesity, truncal vagotomy is a less invasive procedure than gastrointestinal bypass operations requiring anastomoses.…”

Section: Obesitymentioning

confidence: 99%

Vagal Nerve Function in Obesity: Therapeutic Implications

2009

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The primal need for nutrients is satisfied by mechanisms for sensing internal stores and detecting food; ATP is the most primitive signal. With increasing density of sensory neurons and glia (the primordial brain) and the emergence of autonomic neural activity throughout the endoderm, transmitters and other signaling molecules enable alimentation before the appearance of innate storage functions. Memory and, ultimately, cognition are prerequisites for processing and producing food to facilitate assimilation and safeguard the supply of nutrients. The gut-brain-gut axis via the vagus nerve is the autonomic neurohumoral pathway integrating these elements of energy homeostasis. Humans uniquely override obligate nutrient needs, eating in the absence of deprivation, resulting in pathological chronic overnutrition arising from dysautonomia. Obesity surgery circumvents powerful redundant mechanisms of alimentation and reduces excess stores of body fat from chronic overnutrition while preventing re-accumulation of fat. All bariatric operations, whether purely restrictive, maldigestive and malabsorptive, or combinations, rely on regulatory mechanisms related to autonomic nervous system function and the brain-gut axis. We review the functional anatomy and the importance of the vagus nerve for maintaining maladaptive chronic overnutrition and describe interventions to abrogate its effects. In aggregate, the preponderance of evidence supported by laboratory and clinical mechanistic studies interrupting abdominal bi-directional vagal transmission demonstrates that the majority of patients report less "hunger" and lose weight.

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Section: Obesitymentioning

confidence: 99%