Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of General Surgery, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.
Obes Surg. 2020 Aug;30(8):2980-2987. doi: 10.1007/s11695-020-04626-w.
Sleeve gastrectomy is a common bariatric procedure. The aim of this study was to explore the effects and mechanisms of intra-operative vagal nerve stimulation (iVNS) on postoperative recovery after sleeve gastrectomy in rats.
Rats were randomly divided into groups of sham-iVNS (n = 12) and iVNS (n = 12), and received sleeve gastrectomy, and were implanted electrodes for the electrocardiogram (ECG) and gastric pace-making activity or slow wave (GSW). iVNS or sham-iVNS was performed during surgery. Postoperative animal behaviors, pain, gastrointestinal functions, autonomic functions, inflammatory cytokines, and hormones in plasma were assessed.
In comparison with sham-iVNS, (1) iVNS accelerated the first drinking time (P = 0.01) and first defecation time (P = 0.02), increased the weight of stool in postoperative day (POD) 1 (P = 0.01) and POD3 (P = 0.01), and reduced postoperative pain at 24 h after surgery (P = 0.01); (2) physiologically, iVNS improved gastric emptying (P < 0.01) at 72 h after surgery, and increased the dominant frequency (P < 0.01) and the percentage of normal GSW (P = 0.04) at 6 h after surgery; (3) mechanistically, iVNS increased vagal activity and decreased sympathovagal ratio at 6 h (vagal, P < 0.01; sympathovagal ratio, P < 0.01) and 24 h (vagal, P = 0.02; sympathovagal ratio, P = 0.01) after surgery, increased the plasma pancreatic polypeptide (P = 0.03) at 1 h after surgery, and decreased the plasma tumor necrosis factor-α (TNF-α) at 1 h (P = 0.02) and 6 h (P = 0.03) and the plasma interleukin-6 (IL-6) at 1 h (P = 0.02) after surgery.
Intra-operative VNS is effective in accelerating post-surgical recovery in rats after sleeve gastrectomy by enhancing gastric pace-making activity and suppressing proinflammatory cytokines mediated via the autonomic mechanisms.
袖状胃切除术是一种常见的减重手术。本研究旨在探讨术中迷走神经刺激（iVNS）对大鼠袖状胃切除术后恢复的影响及其机制。
将大鼠随机分为假刺激-iVNS 组（n=12）和 iVNS 组（n=12），接受袖状胃切除术，并植入心电图（ECG）和胃起搏活动或慢波（GSW）的电极。术中进行 iVNS 或假刺激-iVNS。术后评估动物行为、疼痛、胃肠功能、自主神经功能、血浆中炎症细胞因子和激素。
与假刺激-iVNS 相比，（1）iVNS 可加快首次饮水时间（P=0.01）和首次排便时间（P=0.02），增加术后第 1 天（P=0.01）和第 3 天（P=0.01）的粪便重量，并减轻术后 24 小时的疼痛（P=0.01）；（2）生理上，iVNS 可改善术后 72 小时的胃排空（P<0.01），并增加术后 6 小时的主导频率（P<0.01）和正常 GSW 的百分比（P=0.04）；（3）机制上，iVNS 可增加术后 6 小时（迷走神经，P<0.01；交感神经-迷走神经比值，P<0.01）和 24 小时（迷走神经，P=0.02；交感神经-迷走神经比值，P=0.01）的迷走神经活动，并降低术后 1 小时的血浆胰多肽（P=0.03），并降低术后 1 小时（P=0.02）和 6 小时（P=0.03）的血浆肿瘤坏死因子-α（TNF-α）和术后 1 小时（P=0.02）的血浆白细胞介素-6（IL-6）。
术中 VNS 通过增强胃起搏活动和抑制自主神经机制介导的促炎细胞因子，有效促进大鼠袖状胃切除术后的术后恢复。
