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Two Centimeter D1–2 Anterior Perforation Presenting 24 Hours Later
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Rationale for choice of the procedure: Simple omental patch closure is a quick procedure ideally suited for patients with significant comorbid illnesses and those who present late with features of shock. The availability of potent anti-secretory agents and antibiotic therapy for Helicobacter pylori have made acid-reducing procedures less preferred. Nonsteroidal anti-inflammatory drug related perforations (as in our patient) usually do not require acid-reducing procedures as the drug can be stopped or substituted in most instances. The location of perforation also determines the surgical approach. A perforation located in the first part of duodenum just beyond the pylorus may be easily incorporated in a pyloroplasty, and hence may be treated with a pyloroplasty. In such situations, a truncal vagotomy can be added. A distally located perforation (as in our case) cannot be included in a pyloroplasty, and thus would require a separate drainage procedure if truncal vagotomy is added. Although, a highly selective vagotomy without a drainage procedure is possible, but it is time consuming and may not be suitable for such sick patients.
Participation of Vagal Sensory Neurons in Putative Satiety Signals from the Upper Gastrointestinal Tract
Published in Sue Ritter, Robert C. Ritter, Charles D. Barnes, Neuroanatomy and Physiology of Abdominal Vagal Afferents, 2020
R.C. Ritter, L. Brenner, D.P. Yox
Surgical vagotomy causes vagal deefferentation as well as deafferentation of the GI tract. The deleterious effects of this procedure for gastrointestinal motility and secretion are well documented. In an effort to assess the role of sensory fibers, as opposed to motor fibers, in suppression of feeding by intestinal nutrients, we have studied the behavioral effects of intestinal nutrient infusion in sham feeding rats previously treated with capsaicin. Capsaicin damages or destroys small unmyelinated sensory neurons in the peripheral nervous system, including those of the vagal and spinal innervations to the GI tract.41,42,73 Vagal motor neurons do not appear to degenerate following capsaicin.73 Our experiments revealed that rats treated systemically with capsaicin no longer reduced their sham feeding when given intraintestinal infusions of maltose or oleic acid90 (Figure 5). Suppression of sham feeding by L-PHE was also diminished but not abolished. These results, taken together with the results of our vagotomy studies, suggest that suppression of food intake by maltose and oleic acid is mediated by capsaicin-sensitive vagal sensory fibers. Suppression of sham feeding by L-PHE, on the other hand, depends in part, but not entirely, on capsaicin-sensitive fibers.
The Digestive (Gastrointestinal) System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Surgical intervention most commonly would involve colectomy and ileostomy for inflammatory bowel disease, vagotomy or antrectomy for peptic ulcer disease, cholecystectomy for inflammation of the gallbladder, appendectomy for inflammation of the appendix, and repair of inguinal hernias by herniorrhaphy. Paracentesis or abdominocentesis (centesis = puncture) is a procedure done to remove fluid from the abdomen or peritoneal cavity.
Is vagal stimulation or inhibition benefit on the regulation of the stomach brain axis in obesity?
Published in Nutritional Neuroscience, 2022
Işınsu Alkan, Berrin Zuhal Altunkaynak, Elfide Gizem Kivrak, Arife Ahsen Kaplan, Gülay Arslan
Studies on the damage of the vagus nerve are quite limited. Ferrari et al. performed a study on obese male Zucker (fa / fa) rats and pointed out that upper intestinal digestion was abolished by vagus inhibition and noted that nutrient intake decreased without changing the insulin level [37]. In addition, vagotomy is generally preferred for vagus suppression. Vagotomy is a surgical procedure that emerged in 1969, used to reduce acidity by denervating acid-producing parietal cells to reduce or prevent symptoms of gastroesophageal reflux and peptic ulcer [38,39]. There are studies showing that obstruction is associated with obstruction of the afferent nerves of the vagus. In a study by Laskiewicz et al., 38% weight loss observed in vagotomy subjects, as well as reported decreased appetite. Again, studies on rodents and humans have shown that vagotomy reduces food intake [10,40,41]. Balbo et al. reported that lipidosis decreased, insulin sensitivity was regained and fat storage was gradually lost in subjects fed high fat diet after vagotomy [42]. In our study, a decrease of 14% in the weight of the rats was determined after vagal inhibition by the application of the cruch injury by 58 newton pressure to the left vagus nerve.
The gut-brain axis and Parkinson disease: clinical and pathogenetic relevance
Published in Annals of Medicine, 2021
Elisa Menozzi, Jane Macnaughtan, Anthony H. V. Schapira
Indirect evidence supporting a central role of the VN in PD pathogenesis comes from large population-based studies where the risk of developing PD has been assessed in people who underwent vagotomy versus matched controls (for a comprehensive review of this topic, the reader is directed elsewhere [30]). Essentially, these studies have shown that vagotomy, especially truncal vagotomy, might reduce the risk of developing PD > 5 years after the procedure [31,32]. A possible explanation why truncal rather than selective vagotomy could reduce the risk of PD might be that the vermiform appendix is the first locus of enteric α-synuclein aggregation, due to its abundant content of α-synuclein [33], the lack of blood-tissue barrier in the mucosa – which makes it more susceptible to environmental triggers [30], and the connection with vagal efferents [34]. Indeed, some observational and population-based studies have reported that appendectomy delayed PD onset [35,36], and even reduced the risk of developing PD by 19.3% [35]. However, two large-scale cohort studies did not confirm these findings, showing a higher incidence of PD in subjects shortly after appendectomy or with long-term follow up after the procedure [37,38]. Overall, these results may support a protective role of vagotomy, whereas an association between appendectomy and reduced risk of PD is less clear.
Cardiac remodeling in obesity and after bariatric and metabolic surgery; is there a role for gastro-intestinal hormones?
Published in Expert Review of Cardiovascular Therapy, 2019
Elijah Sanches, Marieke Timmermans, Besir Topal, Alper Celik, Magnus Sundbom, Rui Ribeiro, Chetan Parmar, Surendra Ugale, Monika Proczko, Pieter S. Stepaniak, Juan Pujol Rafols, Kamal Mahawar, Marc P. Buise, Aleksandr Neimark, Rich Severin, Sjaak Pouwels
GLP-1 has several effects on the central nervous system (CNS) including behavioral responses to stress and anxiety [162], but also effects on the reduction of food intake. These effects occur through two separate routes/mechanisms [112,162,163]. The first mechanism includes the activation of GLP-1 receptors in the hypothalamus, which regulates caloric intake. Secondly, GLP-1 exerts effects in the amygdala and this can induce malaise [163]. These effects occur mainly through caudal brainstem circuits triggered by exogenous hindbrain GLP-1 receptor activation via vagal signals [164]. This also explains that performing a vagotomy can diminish the effects on appetite [116]. It is known that GLP-1 has powerful incretin effects, especially in T2DM and postprandial glucose control, according to several studies [165,166]. RYGB and BPD are known for changes in GLP-1 physiology and indicated a rise of both basal and post-prandial GLP-1 in studies with a short term and also a long-term follow-up (up to 36 months) (Table 1). Only three studies in restrictive surgical procedures (after gastric banding [167,168] and VBG [169]) show no change in GLP-1 levels after surgery. Cigaina et al. [170] showed even a decrease in GLP-1 after gastric pacing.