Review articleAlgorithm to diagnose etiology of hypoglycemia after Roux-en-Y gastric bypass for morbid obesity: case series and review of the literature
Section snippets
Methods
Permission was granted to review the postoperative outcomes and related data from the patients included in the present series from the Duke University institutional review board from our prospectively maintained bariatric surgery database. In the present report, we describe 3 distinct cases of hypoglycemia occurring after LRYGB.
Case 1
A 61-year-old woman was seen in the bariatric clinic for monitoring of weight loss and screening for possible medical complications 2 years after LRYGB. She reported neuroglycopenic symptoms (i.e., lethargy, loss of focus, and malaise) that required a visit to the emergency department and that had resolved with oral glucose treatment but recurred the following day. She denied any use of insulin or oral diabetes medications, and her dietary history failed to demonstrate any excess carbohydrate
Discussion
We report 3 significant cases of hypoglycemia after LRYGB. The expanding MO population in the United States has led to a robust increase in surgery for weight loss and the reduction of co-morbid conditions. In turn, LRYGB has been the primary bariatric procedure of choice owing to its consistent reduction of excess weight and the long-term data supporting its lasting effect and lower wound-related complications compared with open RYGB [18], [19]. Clinically significant hypoglycemia after
Conclusion
Although hypoglycemia after RYGB is not a particularly common complication of the most common primary bariatric procedure, the differential diagnosis varies. The bariatric surgeon must consider the following etiologies when evaluating hypoglycemia: dumping syndrome, factitious insulin use, and nesidioblastosis. A thorough and systematic evaluation, including history, serum biochemical analysis, and diagnostic testing, can distinguish these diagnoses. We have suggested a novel algorithm to
Disclosures
D. D. Portenier received research support and honorarium as a proctor for Allergan and research support and honorarium as a speaker for, and consultant to, Covidien. The remaining authors have no commercial associations that might be a conflict of interest in relation to this article.
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