Truncal vagotomy in morbid obesity.

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.