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

Technical Variations and Considerations around OAGB in IFSO-APC and IFSO-MENAC Chapters, an Expert Survey

OBJECTIVE

This study aimed to evaluate the technical variations of one-anastomosis gastric bypass (OAGB) among IFSO-APC and MENAC experts.

BACKGROUND

The multitude of technical variations and patient selection challenges among metabolic and bariatric surgeons worldwide necessitates a heightened awareness of these issues. Understanding different perspectives and viewpoints can empower surgeons performing OAGB to adapt their techniques, leading to improved outcomes and reduced complications.

METHODS

The scientific team of IFSO-APC, consisting of skilled bariatric and metabolic surgeons specializing in OAGB, conducted a confidential online survey. The survey aimed to assess technical variations and considerations related to OAGB within the IFSO-APC and IFSO-MENAC chapters. A total of 85 OAGB experts participated in the survey, providing their responses through a 35-question online format. The survey took place from January 1, 2024, to February 15, 2024.

RESULTS

Most experts do not perform OAGB for children and adolescents younger than 18 years. Most experts create the gastric pouch over a 36-40-F bougie and prefer to create a gastrojejunostomy, at the posterior wall of the gastric pouch. An anti-reflux suture during OAGB is performed in all patients by 51.8% of experts. Most experts set a common limb length of > 4 m in revisional and conversional OAGBs to prevent nutritional complications.

CONCLUSION

The ongoing debate among metabolic and bariatric surgeons regarding the technical variations and patient selection in OAGB remains a significant point of discussion. This survey demonstrated the variations in technical aspects and patient selection for OAGB among MBS surgeons in the IFSO-APC and IFSO-MENAC chapters. Standardizing the OAGB technique is crucial to ensure optimal safety and efficacy in this procedure.

GLP-1 Increases Circulating Leptin Levels in Truncal Vagotomized Rats

GLP-1 is a gastro-intestinal hormone acting within the gut/brain axis for energy balance regulation. We aimed to evaluate the role of the vagus nerve in whole-body energy homeostasis and in mediating GLP-1 effects. For this, rats submitted to truncal vagotomy and sham-operated controls underwent a comprehensive evaluation, including eating behavior, body weight, percentage of white (WAT) and brown adipose tissue (BAT), resting energy expenditure (REE) and acute response to GLP-1. Truncal vagotomized rats had significantly lower food intake, body weight, body weight gain, WAT and BAT, with a higher BAT/WAT ratio, but no significant difference in REE when compared to controls. Vagotomized rats also had significantly higher fasting ghrelin and lower glucose and insulin levels. After GLP-1 administration, vagotomized rats depicted a blunted anorexigenic response and higher plasma leptin levels, as compared to controls. However, in vitro stimulation of VAT explants with GLP-1 resulted in no significant changes in leptin secretion. In conclusion, the vagus nerve influences whole-body energy homeostasis by modifying food intake, body weight and body composition and by mediating the GLP-1 anorectic response. The higher leptin levels in response to acute GLP-1 administration observed after truncal vagotomy suggest the existence of a putative GLP-1-leptin axis that relies on the integrity of gut-brain vagal pathway.

Effect of Biliopancreatic Limb Length on Weight Loss, Postoperative Complications, and Remission of Comorbidities in One Anastomosis Gastric Bypass: a Systematic Review and Meta-analysis

Aimed to evaluate the effects of biliopancreatic limb (BPL) length on weight loss, postoperative complications, and remission of comorbidities in OAGB.. An extensive search was conducted in PubMed, Scopus, EMBASE, and Google Scholar databases to find related OAGB articles. Both BPL length < 200 cm (by - 17.79, 95% CI - 19.23, - 16.34) and BPL length ≥ 200 cm (by - 14.93, 95% CI - 15.66, - 14.20) significantly decreased BMI. Regarding the effect of BPL length on comorbidities and postoperative complications, it was shown that BPL length < 200 cm is safer and more effective. Therefore, standardization of BPL length < 200 cm is suggested. Bypassing ≥ 200 cm of the small bowel does not ameliorate weight loss or resolve comorbidities significantly, and it is related to more frequent postoperative complications and nutritional deficiencies. Registration number in PROSPERO: PROSPERO 2021 CRD42021225499.

Impact of the Hepatic Branch of the Vagus Nerve Transection in Laparoscopic Sleeve Gastrectomy for Patients with Obesity and Type 2 Diabetes Mellitus

BACKGROUND

An increase in gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) has been reported, and concomitant hiatal hernia repair (HHR) during LSG is expected to reduce the incidence of post-LSG GERD. In HHR, the hepatic branch of the vagus nerve is anatomically transected. Recent experimental animal models suggest that vagotomy may affect glycemic control and weight loss through a neuroendocrine response.

OBJECTIVES

To examine whether LSG with/without hepatic branch vagotomy (HV) has a clinical impact on glycemic control in patients with obesity and type 2 diabetes mellitus (T2DM). Furthermore, the impact on weight loss and post-LSG GERD were evaluated.

METHODS

A total of 204 Japanese patients with obesity and T2DM, who underwent LSG and completed 1-year follow-up, were retrospectively analyzed. Operative outcomes, weight loss, glycemic, and GERD-related parameters were compared between the LSG/HHR/HV group (n = 89) and the LSG group (n = 115).

RESULTS

There was no significant difference in the background factors in terms of anthropometric and T2DM-related parameters between the groups. The median operation times in the LSG/HHR/HV and LSG groups were 133 and 124 minutes, respectively (p = 0.236). At 1 year, the diabetes remission rate, HbA1c, fasting glucose, and C-peptide levels were all comparable between the groups. The weight loss effect was also comparable. The patients in the LSG/HHR/HV group achieved significant improvement and prevention of GERD and hiatus hernia (p < 0.001).

CONCLUSION

HV does not appear to have a clinical impact on glycemic control and weight loss. Concomitant HHR with LSG serves to reduce post-LSG GERD.

Areas of Non-Consensus Around One Anastomosis/Mini Gastric Bypass (OAGB/MGB): A Narrative Review

PURPOSE

One anastomosis/mini gastric bypass (OAGB/MGB) is now an established bariatric and metabolic surgical procedure with good outcomes. Despite two recent consensus statements around OAGB/MGB, there are some issues which are not accepted as consensus and need more long-term data and research.

MATERIAL AND METHODS

After identifying the topic of non-consensus from the two recent OAGB/MGB consensuses, PubMed, Scopus, and Cochrane were searched for articles published by November 2020.

RESULTS

In this study, we evaluated these non-consensus topics around OAGB/MGB and all related articles on these topics were assessed by authors to have an argument on these items.

CONCLUSION

There is enough evidence to include OAGB/MGB as an accepted standard bariatric and metabolic surgical procedure. However, long-term data and more research are needed to have a consensus in all aspects including these non-consensus topics.