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Preservation of the Celiac Branch of the Vagus Nerve during Laparoscopy-assisted Distal Gastrectomy: Impact on Postprandial Changes in Ghrelin Secretion

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Abstract

Background

Ghrelin is a brain-gut peptide with GH-releasing and appetite-inducing properties. Because ghrelin is secreted mainly by the stomach, fasting levels fall after distal gastrectomy. The vagal nerve is responsible for periprandial changes. The presents study investigated the impact of preserving the celiac branch of the vagus nerve during laparoscopy-assisted distal gastrectomy on postoperative ghrelin secretion.

Method

Between May 2009 and July 2010, 42 consecutive patients who underwent LADG were divided into two groups, the first in which the celiac branch of the vagus was preserved (“Preserved,” n = 21) and the second in which it was not (“Not Preserved,” n = 21). Blood samples were collected for assays of several hormones, including ghrelin, leptin, and insulin; these were taken before and 2 h after breakfast on postoperative day 7.

Results

There were no significant differences in the background characteristics of the two groups. Plasma fasting ghrelin decreased significantly after LADG, by about 50 % of the baseline values in both groups. Postprandial plasma ghrelin levels in the Preserved group were significantly lower than those in the Not Preserved group (23 ± 8 vs 32 ± 9 fmol/ml; p = 0.0058). The ratio of the total ghrelin concentration after breakfast to that before was defined as the A/B ratio. The mean preoperative and postoperative A/B ratios were almost the same in the Preserved group (preoperative vs postoperative: 0.41 vs 0.44; p = 0.52). On the other hand, the mean A/B ratio in the Not Preserved group increased from 0.41 to 0.61 postoperatively (preoperative vs postoperative; p = 0.0003). Preservation of the celiac branch of the vagus nerve during LADG was related to the prandial ghrelin changes.

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References

  1. Yunoki Y (1995) Effects of resection of celiac and pyloric branches of vagus nerve on the interdigestive motor activity of the upper digestive tract and biliary tree. J Smooth Muscle Res 31:33–41

    Article  PubMed  CAS  Google Scholar 

  2. Kinami S, Miwa K, Sato T et al (1997) Section of the vagal celiac branch in man reduces glucagon-stimulated insulin release. J Auton Nerv Syst 64:44–48

    Article  PubMed  CAS  Google Scholar 

  3. Uyama I, Sakurai Y, Komori Y et al (2005) Laparoscopic gastrectomy with preservation of the vagus nerve accompanied by lymph node dissection for early gastric carcinoma. J Am Coll Surg 200:140–145

    Article  PubMed  Google Scholar 

  4. Kojima K, Yamada H, Inokuchi M et al (2008) Functional evaluation after vagus-nerve-sparing laparoscopically assisted distal gastrectomy. Surg Endosc 22:2003–2008

    Article  PubMed  Google Scholar 

  5. Yamada H, Kojima K, Inokuchi M et al (2011) Efficacy of celiac branch preservation in Roux-en-Y reconstruction after laparoscopy-assisted distal gastrectomy. Surgery 149:22–28

    Article  PubMed  Google Scholar 

  6. Nakazato M, Murakami N, Date Y et al (2001) A role for ghrelin in the central regulation of feeding. Nature 409(6817):194–198

    Article  PubMed  CAS  Google Scholar 

  7. Kojima M, Hosoda H, Date Y et al (1999) Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature 402(6762):656–660

    Article  PubMed  CAS  Google Scholar 

  8. van der Lely AJ, Tschop M, Heiman ML et al (2004) Biological, physiological, pathophysiological, and pharmacological aspects of ghrelin. Endocr Rev 25:426–457

    Article  PubMed  Google Scholar 

  9. Ariyasu H, Iwakura H, Yamada G et al (2008) Efficacy of ghrelin as a therapeutic approach for age-related physiological changes. Endocrinology 149:3722–3728

    Article  PubMed  CAS  Google Scholar 

  10. Akamizu T, Kangawa K (2006) Translational research on the clinical applications of ghrelin. Endocr J 53:585–591

    Article  PubMed  CAS  Google Scholar 

  11. Date Y, Murakami N, Toshinai K et al (2002) The role of the gastric afferent vagal nerve in ghrelin-induced feeding and growth hormone secretion in rats. Gastroenterology 123:1120–1128

    Article  PubMed  CAS  Google Scholar 

  12. Nakagawa E, Nagaya N, Okumura H et al (2002) Hyperglycaemia suppresses the secretion of ghrelin, a novel growth-hormone-releasing peptide: responses to the intravenous and oral administration of glucose. Clin Sci (Lond) 103:325–328

    CAS  Google Scholar 

  13. Blom WA, Stafleu A, de Graaf C et al (2005) Ghrelin response to carbohydrate-enriched breakfast is related to insulin. Am J Clin Nutr 81:367–375

    PubMed  CAS  Google Scholar 

  14. Sugino T, Hasegawa Y, Kikkawa Y et al (2002) A transient ghrelin surge occurs just before feeding in a scheduled meal-fed sheep. Biochem Biophys Res Commun 295:255–260

    Article  PubMed  CAS  Google Scholar 

  15. Arosio M, Ronchi CL, Beck-Peccoz P et al (2004) Effects of modified sham feeding on ghrelin levels in healthy human subjects. J Clin Endocrinol Metab 89:5101–5104

    Article  PubMed  CAS  Google Scholar 

  16. Takachi K, Doki Y, Ishikawa O et al (2006) Postoperative ghrelin levels and delayed recovery from body weight loss after distal or total gastrectomy. J Surg Res 130:1–7

    Article  PubMed  CAS  Google Scholar 

  17. Monteleone P, Bencivenga R, Longobardi N et al (2003) Differential responses of circulating ghrelin to high-fat or high-carbohydrate meal in healthy women. J Clin Endocrinol Metab 88:5510–5514

    Article  PubMed  CAS  Google Scholar 

  18. Stratton RJ, Stubbs RJ, Elia M (2008) Bolus tube feeding suppresses food intake and circulating ghrelin concentrations in healthy subjects in a short-term placebo-controlled trial. Am J Clin Nutr 88:77–83

    PubMed  CAS  Google Scholar 

  19. Miao FJ, Janig W, Levine JD (1997) Vagal branches involved in inhibition of bradykinin-induced synovial plasma extravasation by intrathecal nicotine and noxious stimulation in the rat. J Physiol 498(Pt 2):473–481

    PubMed  Google Scholar 

  20. Mei N (1983) Recent studies on intestinal vagal afferent innervation. Functional implications. J Auton Nerv Syst 9:199–206

    Article  PubMed  CAS  Google Scholar 

  21. Blackshaw LA, Grundy D, Scratcherd T (1987) Involvement of gastrointestinal mechano- and intestinal chemoreceptors in vagal reflexes: an electrophysiological study. J Auton Nerv Syst 18:225–234

    Article  PubMed  CAS  Google Scholar 

  22. Kennedy T, Connell AM, Love AH et al (1973) Selective or truncal vagotomy? Five-year results of a double-blind, randomized, controlled trial. Br J Surg 60:944–948

    Article  PubMed  CAS  Google Scholar 

  23. Adachi S, Takiguchi S, Okada K et al (2010) Effects of ghrelin administration after total gastrectomy: a prospective, randomized, placebo-controlled phase II study. Gastroenterology 138:1312–1320

    Article  PubMed  CAS  Google Scholar 

  24. Yamamoto K, Takiguchi S, Miyata H et al (2010) Randomized phase II study of clinical effects of ghrelin after esophagectomy with gastric tube reconstruction. Surgery 148:31–38

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2, E2, Yamadaoka, Suita, Osaka, 565-0871, Japan

    Shuji Takiguchi, Yuichiro Hiura, Tsuyoshi Takahashi, Yukinori Kurokawa, Makoto Yamasaki, Kiyokazu Nakajima, Hiroshi Miyata, Masaki Mori & Yuichiro Doki

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  1. Shuji Takiguchi
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  2. Yuichiro Hiura
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  3. Tsuyoshi Takahashi
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  4. Yukinori Kurokawa
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  5. Makoto Yamasaki
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  6. Kiyokazu Nakajima
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  7. Hiroshi Miyata
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  8. Masaki Mori
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  9. Yuichiro Doki
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Correspondence to Shuji Takiguchi.

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Takiguchi, S., Hiura, Y., Takahashi, T. et al. Preservation of the Celiac Branch of the Vagus Nerve during Laparoscopy-assisted Distal Gastrectomy: Impact on Postprandial Changes in Ghrelin Secretion. World J Surg 37, 2172–2179 (2013). https://doi.org/10.1007/s00268-013-2078-6

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  • DOI: https://doi.org/10.1007/s00268-013-2078-6

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