Implication on Bariatric Surgery by Disregarded Neural Related Structures in the Hepato-Bilio-Pancreas-Gastro-Intestinal Tract in the Rat

Abstract

Purpose: The aim of this report is to describe essentially macroscopic anatomical findings; secondarily, some microscopic details, of an evaluation carried out in 300 Wistar rats. This approach was restricted primarily to the neural autonomic innervation of the hepato-bilio-pancreato-gastro-intestinal tract. Methods: In male animals, body weight 150 to 600 g, under eter or tiopental anesthesia, with delicate instruments and the support of a dissecting microscope (Wild), a microscopic analysis (linear neuronal counting) of the submucous and the myenteric ganglionated plexus was performed, respectively, in the duodenal and the stomach antral segment. Results:Table 1. Emphasis was put on several structures, unexpectedly disregarded in the literature, like, e.g, the diagonal antral band (DAB), a connective nervous band extended from the antral-fundic-junction(AFJ) up to the pylorus; the pre-bile duct-nodular-plexus(PBDNP); the neural fibers that jump the duodeno-pancreatic-cleft-plexus (DPCP), first described in the literature by our group in the sixties; the peri-Vaterian-Center (PVC), with its rich neural density, considered a real autonomic -neural-brain (ANB), and a main starting trigger of autonomic-arc-reflexes, primarily upon the pancreatic “revolver”, pivotal background of a model to mimick human biliary acute pancreatitis; the peculiar arrangement of the celiac ganglia and their linking with the PVC through the perivascular neural network of the inferior pancreatico-duodenal-artery(IPDA). In the PVC and the AFJ a greater linear neuronal counting, respectively, of the submucous and myenteric ganglia when compared with their adjacent zones.Table 1: Oral glucose tolerance test- cumulative value 60 minConclusion: The section and reanastomosis at the level of the AFJ is an inducer of antral peptic ulcers that mimick the human one. The PBDNP and the DAB constitute a “carrrefour” of nerve fibers coming from different sources. Neural impulses, either sympathetic and/or peptidergic, starting from them, the same as those originated from th or the DPCP, modulate, at the level of the neural plexuses of the biliary tract and the hepatic gland, their autonomic neural tone background. The surgical interruption of this modulation, e.g, through a “cicatricial barrier” in what we have called the enteric neural plexus freeway (ENPF), induce trophic changes of the pancreatic gland, and, through an enhancement of the hepatic cholinergic tone an increased release of the Lautt postulated factor (hepatic-insulin-sensitizing-substance, HISS) and, consequently, an improved response of the insulin receptors primarily in the skeletal muscle. The latter, if confirmed in humans, might undoubtedly constitute a much simpler and less dangerous approach to the treatment of morbid obesity in the field of bariatric surgery.