Pancreatic endocrine function after total gastrectomy and truncal vagotomy

Area of Science:

• Gastroenterology
• Endocrinology
• Surgical Research

Background:

• Gastric surgery, including total gastrectomy and esophagectomy, can significantly alter gastrointestinal function and hormonal regulation.
• Understanding the impact of different surgical reconstructions on glucose metabolism is crucial for patient management.

Purpose of the Study:

• To evaluate glucose tolerance and hormonal responses in patients after various types of gastric and esophageal surgery.
• To compare the efficacy of interposition versus Roux-Y reconstruction following total gastrectomy in terms of glucose metabolism.

Main Methods:

• Oral and intravenous glucose tolerance tests were conducted on four groups: preoperative patients, and patients with interposition, Roux-Y, or intrathoracic esophagectomy reconstructions.
• Blood glucose, glucagon, and insulin levels were measured to assess metabolic responses.

Main Results:

• All postoperative groups exhibited glucose intolerance compared to preoperative controls.
• Hyperglucagonemia was observed following oral glucose, particularly after truncal vagotomy.
• Glucose intolerance was attributed to elevated glucagon, insulinopenia, and potential nutritional factors.
• Impaired early-phase insulin secretion was noted in surgically treated groups, highlighting the vagus nerve's role in insulin release.
• The interposition operation demonstrated superior glucose tolerance compared to the Roux-Y operation.

Conclusions:

• Surgical alterations to the stomach and vagus nerve significantly impact glucose homeostasis.
• Interposition reconstruction appears to be a more favorable surgical approach than Roux-Y for maintaining glucose tolerance after total gastrectomy.