PMID- 35835160
OWN - NLM
STAT- MEDLINE
DCOM- 20220908
LR  - 20221003
IS  - 1532-8600 (Electronic)
IS  - 0026-0495 (Linking)
VI  - 135
DP  - 2022 Oct
TI  - Metabolic effects of truncal vagotomy when combined with bariatric-metabolic 
      surgery.
PG  - 155263
LID - S0026-0495(22)00141-X [pii]
LID - 10.1016/j.metabol.2022.155263 [doi]
AB  - Bariatric-metabolic surgery (BMS) in patients with obesity frequently leads to 
      remission of concurrent type 2 diabetes mellitus (T2DM), even before body weight 
      loss takes place. This is probably based on the correction of a dysmetabolic 
      cycle in the gastrointestinal physiology of T2DM that includes increased 
      vagus-dependent exocrine pancreatic secretion (EPS) and, hence, amplified 
      digestion and nutrient absorption. The resultant chronic exposure of tissues to 
      high plasma levels of glucose, fatty acids and amino acids causes tissue 
      resistance to the actions of insulin and, at a later stage, beta-cell dysfunction 
      and reduction of insulin release. We hypothesize that the addition of a surgical 
      truncal vagotomy (TV) may improve and solidify the beneficial results of BMS on 
      T2DM by stably decreasing EPS, - hence reducing the digestion and absorption of 
      nutrients -, and increasing incretin secretion as a result of increased delivery 
      of unabsorbed nutrients to the distal intestine. This hypothesis is supported by 
      surgical data from gastrointestinal malignancies and peptic ulcer operations that 
      include TV, as well as by vagal blockade studies. We suggest that TV may result 
      in a stable reduction of EPS, and that its combination with the appropriate type 
      of BMuS, may enhance and sustain the salutary effects of the latter on T2DM.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Kapralou, Athena N
AU  - Kapralou AN
AD  - Athens Euroclinic Hospital, Athens, Greece. Electronic address: 
      athinakapralou@gmail.com.
FAU - Chrousos, George P
AU  - Chrousos GP
AD  - University Research Institute of Maternal and Child Health and Precision 
      Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian 
      University of Athens Medical School, Athens, Greece.
LA  - eng
PT  - Journal Article
DEP - 20220711
PL  - United States
TA  - Metabolism
JT  - Metabolism: clinical and experimental
JID - 0375267
RN  - 0 (Blood Glucose)
RN  - 0 (Insulin)
SB  - IM
MH  - *Bariatric Surgery/methods
MH  - Blood Glucose/metabolism
MH  - *Diabetes Mellitus, Type 2/metabolism
MH  - Humans
MH  - Insulin/metabolism
MH  - *Insulin Resistance
MH  - Vagotomy, Truncal/adverse effects
OTO - NOTNLM
OT  - Bariatric surgery
OT  - Gastrointestinal bypass
OT  - Metabolic surgery
OT  - T2DM
OT  - Type 2 diabetes mellitus
OT  - Vagotomy
COIS- Declaration of competing interest None declared.
EDAT- 2022/07/15 06:00
MHDA- 2022/09/09 06:00
CRDT- 2022/07/14 19:32
PHST- 2022/01/07 00:00 [received]
PHST- 2022/06/30 00:00 [revised]
PHST- 2022/07/04 00:00 [accepted]
PHST- 2022/07/15 06:00 [pubmed]
PHST- 2022/09/09 06:00 [medline]
PHST- 2022/07/14 19:32 [entrez]
AID - S0026-0495(22)00141-X [pii]
AID - 10.1016/j.metabol.2022.155263 [doi]
PST - ppublish
SO  - Metabolism. 2022 Oct;135:155263. doi: 10.1016/j.metabol.2022.155263. Epub 2022 
      Jul 11.