Lagb with Truncal Vagotomy: Any Increased Weight Loss?

Objective: Does truncal vagotomy enhance weight loss when combined with LAGB? Laparoscopic adjustable gastric banding (LAGB) causes weight loss primarily through a mechanical restrictive mechanism. The vagus nerve provides connections between the brain and the gut through afferent and hormonal signals that regulate fullness and satiation. Published studies demonstrate clinically significant weight loss in subjects undergoing open surgical truncal vagotomy for ulcer disease and morbid obesity. The primary objectives of this study were to evaluate the safety and efficacy of adding truncal vagotomy to LAGB and compare weight loss to LAGB alone.
Methods: This open-label case controlled study was conducted at Central Carolina Surgery, PA, a private surgery practice in Greensboro, NC. Since May 2006, 47 subjects with Class II and III obesity underwent LAGB with truncal vagotomy. The anterior and posterior nerves were divided and resected just below the diaphragm and sent to pathology. The primary safety variable was the number of procedure-related adverse events. The primary efficacy variable was the percent excess weight loss (%EWL). Completeness of vagotomy was assessed by direct inspection, pathology confirmation and endoscopic Congo red testing after intravenous Baclofen stimulation. 47 cohorts who were matched for age, sex, and preop BMI were used for the ongoing comparison.
Results: The average enrollment BMI was 45 and average age was 46. There were no intra-operative or unanticipated adverse events. All subjects were discharged in ≤ 24 hours. There was one case of incomplete vagotomy confirmed via pathology. The LAGB/Vagotomy group had an average 34.8 % excess weight loss at an average 17 months post op. The cohort group had an average weight loss of 38.5% of excess body weight at an average 21 months postop. All of the LAGB/vagotomy patients reported an absence of hunger; no diarrhea, gastric outlet obstruction, or dumping was seen.
Conclusions: This data does not support the hypothesis that vagotomy when added to LAGB augments weight loss. None of the vagtomy patients had any of the complications usually attibuted to vagotomy without drainage.

Session: Podium Presentation

Program Number: S057

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