Truncal vagotomy in morbid obesity
J G Kral, L Görtz Int J Obes. 1981;5(4):431-5.
Vagotomy has been shown to reduce body weight in several species of experimental animals. Due to the relative safety and simplicity of the procedure and the long-clinical evaluation of vagotomy in ulcer disease, truncal vagotomy without drainage has been performed in a series of 21 morbidly obese patients. The mean maximum body weight was 12.8 +/- 3 kg (s.e.). In the 14 patients observed for 12-40 months, the mean weight decrease is 20 +/- 4 kg (range: 0-51). Apart from lesion of the oesophagus in one patient, there have been no operative complications. In one 45-year-old patient sudden death due to myocardial fibrosis occurred three years after the operation. Four patients have had short episodes of diarrhea, and vomiting has occurred in two patients who "tested the limits'. There is no evidence of gastric dilatation or ulcers, yet gastric stasis is prevalent. Three patients are failures, two not having reduced and the third regaining 28 of her initial 31 kg weight loss postoperatively. Five patients have participated in programs for weight reduction in which they claim greater ease in complying than before operation, due to the characteristic lack of hunger sensations in all of the successful patients. The mechanisms for weight reduction after vagotomy are not known, yet seem to involve other factors than delayed gastric emptying of solids. Longer follow-up is necessary for evaluation of this procedure in the treatment of morbid obesity.
Percutaneous CT-Guided Cryovagotomy in Patients with Class I or Class II Obesity: A Pilot Trial
Prologo JD et al.: Obesity (Silver Spring). 2019 Aug;27(8):1255-1265.
Objective: This study evaluated the safety of percutaneous CT-guided cryoablation of the vagus nerve (percutaneous cryovagotomy) in participants with class I or class II obesity. The study was an open-label, single-group, prospective pilot investigation designed around safety-related stopping criteria. Twenty participants with 30 > BMI > 37 underwent percutaneous cryovagotomy with follow-up visits at day 7, 45, 90, and 180. Data related to adverse events, technical success, weight loss, quality of life, dietary intake, global impressions of hunger change, activity, and body composition were analyzed. The procedural technical success rate was 100%. There were no adverse events in 19 participants who completed the trial. Ninety-five percent of patients reported decreased appetite following the procedure, and reductions in mean absolute weight and BMI were observed at all time points. The mean quality of life and activity scores improved from baseline to 6 months post procedure, and mean caloric intake and overall body fat decreased over the same period. Percutaneous CT-guided cryovagotomy is feasible and was tolerated without complications or adverse events in this cohort. Quantitative preliminary data from this pilot investigation inform the design of a larger prospective randomized clinical trial.