Active mitral ring for post-surgical remote correction of residual mitral regurgitation on the beating heart.

OBJECTIVES: Residual mitral regurgitation after valve repair worsens patients' clinical outcome. Postimplant adjustable mitral rings potentially address this issue, allowing the reshaping of the annulus on the beating heart under echocardiography control. We developed an original mitral ring allowing valve geometry remodelling after the implantation and designed an animal study to assess device effectiveness in correcting residual mitral regurgitation. METHODS: The device consists of two concentric rings: one internal and flexible, sutured to the mitral annulus and a second external and rigid. A third conic element slides between the two rings, modifying the shape of the flexible ring. This sliding element is remotely activated with a rotating tool. Animal model: in adult swine, under cardio pulmonary bypass and cardiac arrest, we shortened the primary chordae of P2 segment to reproduce Type III regurgitation and implanted the active ring. We used intracardiac ultrasound to assess mitral regurgitation and the efficacy of the active ring to correct it. RESULTS: Severe mitral regurgitation (3+ and 4+) was induced in eight animals, 54 ± 6 kg in weight. Vena contracta width decreased from 0.8 ± 0.2 to 0.1 cm; proximal isovelocity surface area radius decreased from 0.8 ± 0.2 to 0.1 cm and effective regurgitant orifice area decreased from 0.50 ± 0.1 to 0.1 ± 0.1 cm(2). Six animals had a reversal of systolic pulmonary flow that normalized following the activation of the device. All corrections were reversible. CONCLUSIONS: Postimplant adjustable mitral ring corrects severe mitral regurgitation through the reversible modification of the annulus geometry on the beating heart. It addresses the frequent and morbid issue of recurrent mitral valve regurgitation.

Evaluación de un nuevo método de sutura para la cirugía endoscopica transluminal a través de orificios naturales en un modelo animal

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a novel, potentially less invasive alternative to laparoscopic surgery. However, the problems of transluminal access and closure represent significant obstacles to its successful introduction in humans. Objective: to evaluate the feasibility and safety of a novel device designed for transluminal access and closure in a survival porcine model. Subjects: Four adult female Yorkshire pigs were used in the study. Interventions: While under general anesthesia, the animals were prepared with multiple tap water enemas followed by instillation of an antibiotic suspension and povidone-iodine lavage. At a distance of 15 to 20 cm from the anus, the prototype device (LSI Solutions, Victor, NY, USA) deployed a circumscribing purse-string suture around the planned incision site and subsequently used a blade mechanism to create a 2.5-cm linear incision. The transcolonic incision was then closed by cinching and securing the purse-string suture with a titanium knot by use of a separate hand-activated suture-locking device. Main Outcome Measurements: The animals were monitored daily for signs of peritonitis and sepsis and were survived for 14 days. The peritoneal cavity was examined for peritonitis, and the colonic incision site was examined for wound dehiscence, pericolic abscess formation, and gross adhesions. Tissue samples from both incisional and random peritoneal sites were obtained for histologic examination. Results: Transcolonic incision and closure were successful in all 4 animals. The device performed in a rapid and reproducible fashion. All animals recovered without septic complications. At necropsy, there was no evidence of peritonitis, abscesses, or wound dehiscence. Salpingocolonic and colovesicular adhesions were noted in 3 of 4 animals. Histologic examination revealed microabscesses at the incision site in all animals. Conclusions: The prototype incision and closure device represents a promising solution to the problems of transluminal access for NOTES. The presence of incision-related adhesions and microabscesses signal the need for further refinement in aseptic technique. 

Sedimentary record of the northward flight of India and its collision with Eurasia (Ladakh Himalaya, India)

Stratigraphic and petrographic analysis of the Cretaceous to Eocene Tibetan sedimentary succession has allowed us to reinterpret in detail the sequence of events which led to closure of Neotethys and continental collision in the NW Himalaya. During the Early Cretaceous, the Indian passive margin recorded basaltic magmatic activity. Albian volcanic arenites, probably related to a major extensional tectonic event, are unconformably overlain by an Upper Cretaceous to Paleocene carbonate sequence, with a major quartzarenite episode triggered by the global eustatic sea-level fall at the Cretaceous/Tertiary boundary. At the same time, Neotethyan oceanic crust was being subducted beneath Asia, as testified by calc-alkalic volcanism and forearc basin sedimentation in the Transhimalayan belt. Onset of collision and obduction of the Asian accretionary wedge onto the Indian continental rise was recorded by shoaling of the outer shelf at the Paleocene/Eocene boundary, related to flexural uplift of the passive margin. A few My later, foreland basin volcanic arenites derived from the uplifted Asian subduction complex onlapped onto the Indian continental terrace. All along the Himalaya, marine facies were rapidly replaced by continental redbeds in collisional basins on both sides of the ophiolitic suture. Next, foreland basin sedimentation was interrupted by fold-thrust deformation and final ophiolite emplacement. The observed sequence of events compares favourably with theoretical models of rifted margin to overthrust belt transition and shows that initial phases of continental collision and obduction were completed within 10 to 15 My, with formation of a proto-Himalayan chain by the end of the middle Eocene.

Systematized stenting of Baerveldt shunts: techniques to reduce early post-operative hypotony

Purpose: To investigate the effect of the systematized use of intraluminal stents in Baerveldt shunts (BS) on early postoperative IOP control and complication rates. Methods: One hundred and twenty eyes with medically uncontrolled glaucoma were prospectively recruited to undergo BS implantation at Jules Gonin Eye Hospital, Switzerland. Baerveldt shunts were stented (full-length of the intraluminal tube) using a Supramid® 3.0 suture. A minority of shunts (37%) were also ligated intraoperatively and laser suture lysis performed postoperatively. Stent removals, either partial (retraction of 5mm) or complete, were carried out according to a predetermined protocol. Surgery was considered a success when IOP was ≤ 21mmHg and a minimum of 20% reduction from baseline was achieved with/without glaucoma medication (GMs). Hypotony related complications were defined as: choroidal effusions, shallow AC, hypotonous maculopathy or IOP≤5mmHg for over 2 weeks. Results: Mean age was 61.8 years (± standard deviation; ±21.5). Mean follow-up was 17.1 (±7.9) months. Mean preoperative IOP was 26.9 mmHg; mean IOP on the last visit 13.2 mmHg (p<0.001). At year one, the success rate was 87%. In 90% of eyes, IOP was ≤18 mmHg at last visit. Mean number of preoperatively GMs was 3.1; postoperatively 1.4 (p<0.001). Stent removals were performed in 87% of eyes (24% partial; 61% complete). 13% of eyes required no stent removal to reach target IOP. Complications were minor and infrequent (16%) and only 7% were hypotony related. Conclusions: Systematized use of intraluminal stents with Baerveldt aqueous shunts resulted in gradual and controlled IOP lowering with minimal hypotony-related complications. This may have important implications on clinical practice, given the rising rates of aqueous shunt implantation.

An alternative plate tectonic model for the Palaeozoic-Early Mesozoic Palaeotethyan evolution of Southeast Asia (northern Thailand-Myanmar)

An alternative model for the geodynamic evolution of Southeast Asia is proposed and inserted in a modern plate tectonic model. The reconstruction methodology is based on dynamic plate boundaries, constrained by data such as spreading rates and subduction velocities; in this way it differs from classical continental drift models proposed so far. The different interpretations about the location of the Palaeotethys suture in Thailand are revised, the Tertiary Mae Yuam fault is seen as the emplacement of the suture. East of the suture we identify an Indochina derived terrane for which we keep the name Shan-Thai, formerly used to identify the Cimmerian block present in Southeast Asia, now called Sibumasu. This nomenclatural choice was made on the basis of the geographic location of the terrane (Eastern Shan States in Burma and Central Thailand) and in order not to introduce new confusing terminology. The closure of the Eastern Palaeotethys is related to a southward subduction of the ocean, that triggered the Eastern Neotethys to open as a back-arc, due to the presence of Late Carboniferous-Early Permian arc magmatism in Mergui (Burma) and in the Lhasa block (South Tibet), and to the absence of arc magmatism of the same age East of the suture. In order to explain the presence of Carboniferous-Early Permian and Permo-Triassic volcanic arcs in Cambodia, Upper Triassic magmatism in Eastern Vietnam and Lower Permian-Middle Permian arc volcanites in Western Sumatra, we introduce the Orang Laut terranes concept. These terranes were detached from Indochina and South China during back-arc opening of the Poko-Song Ma system, due to the westward subduction of the Palaeopacific. This also explains the location of the Cathaysian West Sumatra block to the West of the Cimmerian Sibumasu block.

Fonctions du plancher pelvien: de la phase expulsive à la consultation du post-partum [Pelvic floor functions: from the beginning of the second phase of labor to the postpartum consultation].

Vaginal delivery can cause lesions of the various pelvic structures responsible for the mechanisms of continence. These lesions may perhaps be prevented in the future by measuring pressure generated during childbirth. Tear of the anal sphincter during childbirth is a marker of a global impairment of the urinary, ano-rectal and sexual pelvic functions in the short and medium term. Persistence of a defect of the anal sphincter is frequent in spite of immediate suture. The correlation between these defects and ano-rectal incontinence are not established in our experience. The quality of the contraction of the sphincter complex and pubo-rectal sling seems to play a more important role in ano-rectal continence after a traumatic childbirth.

The transventricular-transseptal access to the aortic root: a new route for extrapleural trans-catheter aortic stent-valve implantation.

Objective: The aim of this study was to investigate the feasibility of transventricular-transseptal approach (TVSA) for extrapleural transcatheter aortic valved stent implantation via a subxyphoidian access. Methods: In five porcine experiments (52.3 +/- 10.9 kg) the right ventricle was exposed via subxyphoidian access. Under the guidance of intracardiac echocardiography (ICE) and fluoroscopy, the transseptal access from right ventricle to left ventricle was created progressively by puncture and dilation with dilators (8F-26F). Valved stents built in-house from commercial tanned pericardium and self-expandable Nitinol stents were loaded into a cartridge. A delivery sheath was then introduced from the right ventricle into the left ventricle and then into the ascending aorta. The cartridge was connected and the valved stent was deployed in the aortic position. Then, the ventricular septal access was sealed with an Amplatzer septal occluder device and the right ventricular access was closed by tying prepared purse-string suture directly. Thirty minutes after the whole procedure, the animals were sacrificed for macroscopic evaluation of the position of valved stent and septal closure device. Result: Procedural success of TVSA was 100% at the first attempt. Mean procedure time was 49 +/- 4 min. Progressive dilatation of the transseptal access resulted in a measurable ventricular septal defect (VSD) after dilator sizes 18F and more. All valved stents were delivered at the target site over the native aortic valve with good acute valve function and no paravalvular leaks. During the procedure, premature beats (5/5) and supraventriclar tachycardias (5/5) were observed, but no atrial-ventricular block (0/5) occurred. Heart rate before (after) was 90 +/- 3 beats min(-1) (100 +/- 2 beats min(-1): p < 0.05), whereas blood pressure was 60 + 1 mm Hg (55 + 2 mm Hg (p < 0.05)). Total blood loss was 280 + 10 ml. The Amplatzer septal occluder devices were fully deployed and the ventricular septal accesses were sealed successfully, without detectable residual shunt. Conclusion: Trans-catheter implantation of aortic valved stent via extrapleural transventricular-transseptal access is technically feasible and has the potential for a simplified procedure under local anaesthesia. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B. V. All rights reserved.

Early Carboniferous age of the Versoyen ophiolites and consequences: non-existence of a "Valais ocean'' (Lower Penninic, western Alps)

Ophiolites occur at several places in the Lower Penninic of the W and Central Alps. They are generally ascribed to oceanic crust of a so-called ``Valais ocean'' of Cretaceous age which plays a fundamental role in many models of Alpine paleogeography and geodynamics. The type locality and only observational base for the definition of a ``Valais ocean'' in the W Alps is the Versoyen ophiolitic complex, on the French-Italian boundary W of the Petit St-Bernard col. The idea of a "Valais ocean'' is based on two propositions that are since 40 years the basis for most reconstructions of the Lower Penninic: (1) The Versoyen forms the (overturned) stratigraphic base of the Cretaceous-Tertiary Valais-Tarentaise series; and (2) it has a Cretaceous age. We present new field and isotopic data that severely challenge both propositions. (1) The base of the Versoyen ophiolite is a thrust. It overlies a wildflysch with blocks of Versoyen rocks, named the Mechandeur Formation. This ``supra-Tarentaise'' wildflysch has been confused with an (overturned) stratigraphic transition from the Versoyen to the Valais-Tarentaise series. Thus the contact Versoyen/Tarentaise is not stratigraphic but tectonic, and the Versoyen ophiolite has no link with the Valais basin. This thrust corresponds to an inverse metamorphic discontinuity and to an abrupt change in tectonic style. (2) The contact of the Versoyen complex with the overlying Triassic-Jurassic Petit St-Bernard (PSB) series is stratigraphic (and not tectonic as admitted by all authors since 50 years). Several types of sedimentary structures polarize it and show that the PSB series is younger than the Versoyen. Consequently the Versoyen ophiolitic complex is Paleozoic and forms the basement of the PSB Mesozoic sediments. They both belong to a single tectonic unit, named the Versoyen-Petit St-Bernard nappe. (3) Ion microprobe U-Pb isotopic data on zircons from the main gabbroic intrusion in the Versoyen complex give a crystallization age of 337.0 +/- 4.1 Ma (Visean, Early Carboniferous). These zircons show typical oscillatory zoning and no overgrowth or corrosion. and are interpreted to date the Versoyen magmatism. These U-Pb data are in excellent agreement with our field observations and confirm the Paleozoic age of the Versoyen ophiolite. The existence of a ``Valais ocean'' of Cretaceous age in the W Alps becomes very improbable. The eclogite facies metamorphism of the Versoyen-Petit St-Bernard nappe results from an Alpine intra-continental subduction, guided by a Paleozoic oceanic suture. This is an example of the lone term influence of inherited deep-seated structures on a Much younger orogeny. This might well be a major cause of of the inherent complexity of the Alps.

Gastric banding induces negative bone remodelling in the absence of secondary hyperparathyroidism: potential role of serum C telopeptides for follow-up.

OBJECTIVE: Data about the consequences of laparoscopic adjustable gastric banding (LAGB) on phospho-calcic and bone metabolism remain scarce. SUBJECTS: We studied a group of 37 obese premenopausal women (age: 24-52 y; mean BMI = 43.7 kg/m2) who underwent LAGB. METHODS: Serum calcium, phosphate, alkaline phosphatase, parathormone (PTH), vitamin D3, serum C-telopeptides, IGFBP-3 and IGF-1 were measured at baseline, 6, 12, 18 and 24 months after surgery. Body composition, bone mineral content (BMC) and density (BMD) were measured using dual-X-ray absorptiometry (DXA) at baseline, 6, 12 and 24 months after surgery. RESULTS: There was no clinically significant decrease of calcemia; PTH remained stable. Serum telopeptides increased by 100% (P < 0.001) and serum IGFBP-3 decreased by 16% (P < 0.001) during the first 6 months, and then stabilized, whereas IGF-1 remained stable over the 2 y. BMC and BMD decreased, especially at the femoral neck; this decrease was significantly correlated with the decrease of waist and hip circumference. CONCLUSIONS: We concluded that there was no evidence of secondary hyperparathyroidism 24 months after LAGB. The observed bone resorption could be linked to the decrease of IGFBP-3, although this decrease could be attributable to other confounding factors. Serum telopeptides seem to be a reliable marker of bone metabolism after gastric banding. DXA must be interpreted cautiously during major weight loss, because of the artefacts caused by the important variation of fat tissue after LAGB.

Fine structure of Henneguya hemiodopsis sp. n. (Myxozoa), a parasite of the gills of the Brazilian teleostean fish Hemiodopsis microlepes (Hemiodontidae)

A fish-infecting myxosporean, Henneguya hemiodopsis sp. n., found infecting the gills of Hemiodopsis microlepis and collected from the Poty River near the city of Teresina, Brazil, was described based on ultrastructural studies. The parasite occurred within large whitish polysporic plasmodia (up to 200 μm in diameter) containing asynchronous developmental sporogonic stages, mainly mature spores. The spores measured 19.7 ± 0.9 μm in total length (n = 30) and the ellipsoidal spore body was 10.8 ± 0.5 μm long, 3.3 ± 0.4 μm wide and 2.5 ± 0.5 μm thick. The spores were composed of two equal shell valves adhering together along the straight suture line, with each valve having equal-sized caudal tapering tails measuring 8.7 ± 0.6 μm in length. The spores were surrounded by a thin anastomosed network of microfibrils, more evident on the tails. There were two symmetric elongated bottle-like polar capsules 3.5 ± 0.3 μm long and 1.0 ± 0.2 μm wide, each with a polar filament with five to six coils. Given the morphological and ultrastructural differences from previously described parasites and the specificity of the host species, we propose a new species, named H. hemiodopsis sp. n.

Exhumation history of eastern Ladakh revealed by 40Ar/39Ar and fission-track ages: the Indus River-Tso Morari transect, NW Himalaya

Fission-track and (40)Ar/(39)Ar ages place time constraints on the exhumation of the North Himalayan nappe stack, the Indus Suture Zone and Molasse, and the Transhimalayan Batholith in eastern Ladakh (NW India). Results from this and previous studies on a north-south transect passing near Tso Morari Lake suggest that the SW-directed North Himalayan nappe stack (comprising the Mata, Tetraogal and Tso Morari nappes) was emplaced and metamorphosed by c. 50-45 Ma, and exhumed to moderately shallow depths (c. 10 km) by c. 45-40 Ma. From the mid-Eocene to the present, exhumation continued at a steady and slow rate except for the root zone of the Tso Morari nappe, which cooled faster than the rest of the nappe stack. Rapid cooling occurred at c. 20 Ma and is linked to brittle deformation along the normal Ribil-Zildat Fault concomitant with extrusion of the Crystalline nappe in the south. Data from the Indus Molasse suggest that sediments were still being deposited during the Miocene.

Anal mucosectomy for haemorrhoids: should we start to speak Chinese?

AIM: Circular stapled mucosectomy is the standard therapy for the treatment of symptomatic third-degree haemorrhoids and mucosal prolapse. Recently, new staplers made in China have entered the market offering an alternative to the PPH stapling devices. The aim of this prospective randomized study was to compare the safety and efficacy of these new devices. METHODS: Fifty patients with symptomatic third-degree haemorrhoids were randomized to mucosectomy either by using stapler A (CPH32; Frankenman International Ltd, Hong Kong, China; n = 25) or stapler B (PPH03; Ethicon Endo-Surgery, Spreitenbach, Switzerland; n = 25). All procedures were performed by two experienced surgeons. After the stapler was fired by one surgeon, the other surgeon, who was blinded for stapler type, evaluated the stapler line. Postoperative outcome including pain, complications and patient satisfaction were analysed. RESULTS: Demographic and clinical features were no different between the groups. There was no significant difference regarding venous bleeding (P = 0.55), but arterial bleeding was significantly more frequent when stapler B was used (P < 0.001). This led to significantly more suture ligations (P = 0.002). However, no differences regarding operation time (P = 0.99), weight of the resected mucosa (P = 0.81) and height of the stapler line (anterior, P = 0.18; posterior, P = 0.65) were detected. Postoperative pain scores (visual analogue scale) and patient satisfaction were no different either (P = 0.91 and P = 0.78, respectively). No recurrence or incontinence occurred during follow-up. CONCLUSIONS: CPH32 required significantly fewer sutures for bleeding control along the stapler line after circular mucosectomy. However, operation time, rate of postoperative complications and patient satisfaction were similar in both groups.

Genetic consequences of the ice ages on nurseries of the bat Myotis myotis: a mitochondrial and nuclear survey.

Analyses of mitochondrial DNA (mtDNA) control region polymorphism and of variation at 10 nuclear microsatellite loci were used to investigate the mechanisms and genetic consequences of postglacial expansion of Myotis myotis in Europe. Initial sampling consisted of 480 bats genotyped in 24 nursery colonies arranged along a transect of approximately 3000 km. The phylogeographical survey based on mtDNA sequences revealed the existence of major genetic subdivisions across this area, with several suture zones between haplogroups. Such zones of secondary contact were found in the Alps and Rhodopes, whereas other potential barriers to gene flow, like the Pyrenees, did not coincide with genetic discontinuities. Areas of population admixture increased locally the genetic diversity of colonies, which confounded the northward decrease in nucleotide diversity predicted using classical models of postglacial range expansion. However, when analyses were restricted to a subset of 15 nurseries originating from a single presumed glacial refugium, mtDNA polymorphism did indeed support a northwards decrease in diversity. Populations were also highly structured (PhiST = 0.384). Conversely, the same subset of colonies showed no significant latitudinal decrease in microsatellite diversity and much less population structure (FST = 0.010), but pairwise genetic differentiation at these nuclear markers was strongly correlated with increasing geographical distance. Together, this evidence suggests that alleles carried via male bats have maintained enough nuclear gene flow to counteract the effects of recurrent bottlenecks generally associated with recolonization processes. As females are highly philopatric, we argue that the maternally transmitted mtDNA marker better reflects the situation of past, historical gene flow, whereas current levels of gene flow are better reflected by microsatellite markers.

Le contact Gondwana - péri-Gondwana dans le Zanskar oriental (Ladakh-Himalaya)

A l'Est du fleuve Zanskar (Ladakh), la zone de suture de l'Indus sépare les nappes de la bordure nord-indienne du Gondwana (Haut-Himalaya, nappes du Zanskar, cristallin de Tso Morari) des éléments péri·gondwaniens du Trans-himalaya. Des recherches géologiques entreprises entre l'Indus el la Tsarap ont montré que: - la molasse autochlone du Ladakh est surmontée par un édifice de flysch et molasses tertiaires, rétrocharrié vers le NordEst et coiffé par les conglomérats post· éocène moyen du Stok Kangri et une formation eontinentale de molasse rouge; - - la zone de suture comprend deux unités. principales : a) au Nord et au Nord-Ouest, l'unité volcano-sédimentaire de Dras-Nindam avec des conglomérats et flysch crétacés, des brèches massives à radiolarHes et roches vertes; cette unité est accompagnée d'un mélange coloré à roches ultra-basiques, blocs exoti(Iues divers et une méga lentille de brèche carbonatée polygénique à grands Foraminifères (Nummulites ?) ; b) au Sud, l'unité de la Markha, un flysch à lentilles de calcaires plus ou moins marmoréens datée de la base du Jurassique moyen et que nons corrélons avec le Oysch de Lamayuru ; - l'unité complexe de Nimaling représente la terminaison occidentale du crist allin de Rupshn (Tso MOI'ari) ; il comprend un socle gneissique, des roches vert.es et une couverture de schistes quartzitiques, quartzites el dolomies. Cet ensemble est intrudé pal' un granite porphyrique et il est surmonté, en contact tectonique, par une épaisse série métamorphique de calcschistes, shales et grès de faciès schistes lustrés, d'âge inconnu; dans ce tte série, on note au moins trois phases de fortes déformaljons superposées (linéations replissées) ; le long de la vallée de la Markha, le style st.ructural évoque, avec des plis isoclinaux de 2" phase à axes verticaux, une « zone de racine" et pourrait également témoigner de mouvements horizontaux importants; - l'édifice des napp es du Zanskar a été subdivisé en trois unités; il surmonte vers le Nord-Est les schistes lustrés du groupe de Langtang et vient buter vers le Sud-Ouest, le long d'un aceident chevauchant, contre la nappe de Zangla (Haut Himalaya). Les séries sédimentaires (Trias - Crétacé supérieur) sont d'affinité téthysienne. De nouvelles datations sont apportées et nous mettons en évidence, directement à l'Est du fleuve Zanskar, la présence de Crétacé sous faciès calcaires multicolores à microfaune planctique ; transgressif sur les grès de Giumal, ce faciès calcaire déhut.e déjà dans l'Alhien supérieur, c'est-à-dire nellement plus tôt que dans les régions plus orientales de l 'Himalaya; - les nappes du Haut Himalaya comprennent du Nord-Est vers le Sud-Ouest la nappe de Zangla qui chevauche par l'intermédiaire d'une semelle de « Panjal Traps » des témoins écaillés de Paléozoïque inférieur, puis la nappe de cristallin. La nappe de Zangla correspond à l'unité qui, à l 'Ouest du Zanskar supporte la klippe ophiolitique de Spongtang.

Intestinal gluconeogenesis is a key factor for early metabolic changes after gastric bypass but not after gastric lap-band in mice.

Unlike the adjustable gastric banding procedure (AGB), Roux-en-Y gastric bypass surgery (RYGBP) in humans has an intriguing effect: a rapid and substantial control of type 2 diabetes mellitus (T2DM). We performed gastric lap-band (GLB) and entero-gastro anastomosis (EGA) procedures in C57Bl6 mice that were fed a high-fat diet. The EGA procedure specifically reduced food intake and increased insulin sensitivity as measured by endogenous glucose production. Intestinal gluconeogenesis increased after the EGA procedure, but not after gastric banding. All EGA effects were abolished in GLUT-2 knockout mice and in mice with portal vein denervation. We thus provide mechanistic evidence that the beneficial effects of the EGA procedure on food intake and glucose homeostasis involve intestinal gluconeogenesis and its detection via a GLUT-2 and hepatoportal sensor pathway.