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Laparoscopic adjustable gastric banding with truncal vagotomy: any increased weight loss?

机译：腹腔镜可调式胃创口与截断迷走神经切断术：体重增加了吗？

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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(2), 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.
机译：背景：腹腔镜可调胃束带（LAGB）主要通过机械限制机制引起体重减轻。迷走神经通过调节饱腹感和饱腹感的传入和激素信号在大脑和肠道之间提供连接。已发表的研究表明，由于溃疡性疾病和病态肥胖而接受开放式手术截肢迷走神经切断术的受试者具有临床上显着的体重减轻。这项研究的主要目的是评估向LAGB添加截断迷走神经切断术的安全性和有效性，并比较与单独使用LAGB的减肥效果。方法：这项开放性病例对照研究是在宾夕法尼亚州中卡罗来纳州外科医院进行的，这是北卡罗来纳州格林斯伯勒的一家私人减肥手术诊所。自2006年5月以来，对49位2级和3级肥胖的受试者进行了LAGB截断迷走神经切断术。将前神经和后神经分开并在the肌下方切除，并送入病理检查。主要的安全性变量是与程序相关的不良事件的数量。主要功效变量是多余的体重减轻百分比（％EWL）。静脉注射巴氯芬刺激后，通过直接检查，显微镜确认和内镜刚果红试验评估迷走神经切断术的完整性。为了进行持续的比较，对49个队列进行了年龄，性别和术前体重指数（BMI）的匹配。结果：入组时，平均BMI为45 kg / m（2），平均年龄为46岁。没有发生术中或意料之外的不良事件。所有受试者均在不到24小时内出院。经病理评估证实为不完全迷走神经切断术的一例。 LAGB加迷走神经切断术组在术后34个月的平均EWL为38％，队列组在术后36个月的平均EWL为36％。所有迷走神经切断术患者均报告没有饥饿。没有腹泻，没有明显的胃出口阻塞，也没有倾倒。结论：研究数据不支持将迷走神经切开术添加到LAGB会减轻体重的假说。

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