Laparoscopic Gastric Bypass Reversal with Concomitant Sleeve Gastrectomy (SG) for Refractory Hypoglycemia: an Unusual Pr
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MULTIMEDIA ARTICLE
Laparoscopic Gastric Bypass Reversal with Concomitant Sleeve Gastrectomy (SG) for Refractory Hypoglycemia: an Unusual Procedure Claude Tayar 1 & Haydar A. Nasser 2
&
Dana Lawand 3 & Ammar Ghazale 4
Received: 22 June 2020 / Revised: 23 October 2020 / Accepted: 26 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Post-bariatric surgery hypoglycemia is usually seen in patients with a history of gastric bypass surgery [1], and few experience severe symptoms [2]. The pathophysiology of post-gastric bypass surgery hypoglycemia is not well understood, and many theories have been proposed: excessive GLP-1, nesidioblastosis, and increased glucose effectiveness [3]. Thus, the etiology of this condition is complex. Laparoscopic GBP reversal is a very unusual procedure and indications may include excessive weight loss, unexplained GI tract symptoms, and severe hypoglycemia. Hypoglycemia should be managed non-surgically at first, but in case of medical therapy failure, surgical options may be considered. Surgical options include gastrostomy tube placement, gastric bypass reversal [4], or gastric bypass reversal with concomitant sleeve gastrectomy [5–7]. A partial reversal was also mentioned in the literature [6]. Laparoscopic conversion to a sleeve gastrectomy for hypoglycemia is unusual and converting an open gastric bypass to a laparoscopic sleeve gastrectomy is exceptional, even never reported. In this video (run time 6 min and 48 s), we present our procedure, which was performed by adopting a new technique. Patient and Methods A 52-year-old lady was referred to us for hypoglycemia following an open gastric bypass revision that was done in 2012. Her past surgical history includes 2 laparoscopic gastric band surgeries with subsequent removal of the bands, open bypass surgery in 2007 and open bypass surgery revision in 2012. History goes back to 12 months ago when the patient started complaining of fatigue, lassitude, and symptoms consistent with Whipple’s triad. OGTT (oral glucose tolerance test) showed low glucose levels at Supplementary Information The online version contains 2 h (2.7 mmol/l) and at 3 h (3.3 mmol/l). Serum insulin supplementary material available at https://doi.org/10.1007/s11695-020level and C-peptide were normal. The patient was diag05090-2. nosed as having early dumping syndrome (reactive hypoglycemia). She was started on sitagliptin 1 tab once daily * Haydar A. Nasser with dietary changes. Despite this management, she was [email protected] hospitalized several times for worsening of her symptoms. Claude Tayar When referred to our department, the patient asked about [email protected] the possibility of a laparoscopic intervention, since she has suffered a lot from her previous laparotomy incisions. Dana Lawand [email protected] The laparoscopic surgery intervention was discussed with the patient and it was a challenging option in this case. The patient Ammar Ghazale [email protected] was placed in the lithot
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