title: Preservation of the celiac branch of the vagus nerve during laparoscopy-assisted distal gastrectomy: impact on postprandial changes in ghrelin secretion.
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.
  
  
  METHODS
  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.
authors: Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2, E2, Yamadaoka, Suita, Osaka 565-0871, Japan. stakiguchi@gesurg.med.osaka-u.ac.jp
authors: Shuji
authors: S
authors: Takiguchi
authors: Yuichiro
authors: Y
authors: Hiura
authors: Tsuyoshi
authors: T
authors: Takahashi
authors: Yukinori
authors: Y
authors: Kurokawa
authors: Makoto
authors: M
authors: Yamasaki
authors: Kiyokazu
authors: K
authors: Nakajima
authors: Hiroshi
authors: H
authors: Miyata
authors: Masaki
authors: M
authors: Mori
authors: Yuichiro
authors: Y
authors: Doki
mesh_terms: D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D054439:Ghrelin / Q000378:metabolism*; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period / Q000502:physiology*; D011446:Prospective Studies; D013270:Stomach / Q000294:innervation; D013274:Stomach Neoplasms / Q000503:physiopathology / Q000601:surgery; D014630:Vagus Nerve / Q000033:anatomy & histology / Q000601:surgery*
chemical_list: D054439:Ghrelin
references: J Surg Res. 2006 Jan;130(1):1-7
references: 16182310
references: Surgery. 2011 Jan;149(1):22-8
references: 20417538
references: Am J Clin Nutr. 2005 Feb;81(2):367-75
references: 15699223
references: Surg Endosc. 2008 Sep;22(9):2003-8
references: 18594924
references: Gastroenterology. 2010 Apr;138(4):1312-20
references: 20060830
references: Gastroenterology. 2002 Oct;123(4):1120-8
references: 12360474
references: J Physiol. 1997 Jan 15;498 ( Pt 2):473-81
references: 9032694
references: Endocrinology. 2008 Jul;149(7):3722-8
references: 18372331
references: J Am Coll Surg. 2005 Jan;200(1):140-5
references: 15631934
references: Surgery. 2010 Jul;148(1):31-8
references: 20096432
references: Nature. 2001 Jan 11;409(6817):194-8
references: 11196643
references: Clin Sci (Lond). 2002 Sep;103(3):325-8
references: 12193159
references: J Auton Nerv Syst. 1987 Mar;18(3):225-34
references: 3571829
references: Endocr Rev. 2004 Jun;25(3):426-57
references: 15180951
references: Nature. 1999 Dec 9;402(6762):656-60
references: 10604470
references: Biochem Biophys Res Commun. 2002 Jul 12;295(2):255-60
references: 12150940
references: J Auton Nerv Syst. 1983 Oct;9(1):199-206
references: 6363498
references: J Clin Endocrinol Metab. 2004 Oct;89(10):5101-4
references: 15472212
references: J Auton Nerv Syst. 1997 May 12;64(1):44-8
references: 9188084
references: J Clin Endocrinol Metab. 2003 Nov;88(11):5510-4
references: 14602798
references: Am J Clin Nutr. 2008 Jul;88(1):77-83
references: 18614727
references: Endocr J. 2006 Oct;53(5):585-91
references: 16873986
references: J Smooth Muscle Res. 1995 Apr;31(2):33-41
references: 7549047
references: Br J Surg. 1973 Dec;60(12):944-8
references: 4587580