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Cureus Nov 2023Obesity is a global public health crisis associated with numerous medical conditions and increased mortality rates. Weight loss surgery, or bariatric surgery, has become... (Review)
Review
Obesity is a global public health crisis associated with numerous medical conditions and increased mortality rates. Weight loss surgery, or bariatric surgery, has become a crucial treatment option for clinically severe obesity. Bariatric surgery is an effective treatment for severe obesity but it carries the potential for various complications, both in the short and long term. This article provides a comprehensive overview of these complications, aiding healthcare professionals in their management and patients in understanding the risks associated with bariatric surgery. The review explores the short-term complications of bariatric surgery, emphasizing anastomotic leaks, strictures, hemorrhages, infections, marginal ulcers, gastroesophageal reflux disease (GERD), and dumping syndrome. It provides insights into the diagnosis and management of these complications, emphasizing the importance of early recognition and intervention. Furthermore, the article delves into the late complications of adjustable gastric banding (LAGB), vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch (BPDDS). It discusses complications such as band slippage and erosion in LAGB, nutritional deficiencies in VSG and RYGB, and unique complications related to BPDDS.
PubMed: 38084166
DOI: 10.7759/cureus.48580 -
Annual Review of Nutrition May 2024Bariatric surgery is an important weight loss tool in individuals with severe obesity. It is currently the most effective long-term weight loss treatment that lowers... (Review)
Review
Bariatric surgery is an important weight loss tool in individuals with severe obesity. It is currently the most effective long-term weight loss treatment that lowers obesity-related comorbidities. It also has significant physiological and nutritional consequences that can result in gastrointestinal complications and micronutrient deficiencies. After gastric bypass, common clinical events that negatively affect nutritional status include malabsorption, dumping syndrome, kidney stones, altered intestinal bile acid availability, bowel obstruction, ulcer, gastroesophageal reflux, and bacterial overgrowth. Risk factors for poor nutritional status and excessive loss of lean body mass and bone include reduced dietary quality and inadequate intake, altered nutrient absorption, and poor patient compliance with nutrient supplementation. There are unique concerns in adolescents, older individuals, and individuals who become pregnant postoperatively. With careful management, health-care professionals can assist with long-term weight loss success and minimize the risk of acute and long-term nutrition complications after bariatric surgery.
PubMed: 38768613
DOI: 10.1146/annurev-nutr-061121-101547 -
Diabetes/metabolism Research and Reviews Feb 2024Post-bariatric hypoglycaemia (PBH) is a metabolic complication of bariatric surgery (BS), consisting of low post-prandial glucose levels in patients having undergone... (Review)
Review
Post-bariatric hypoglycaemia (PBH) is a metabolic complication of bariatric surgery (BS), consisting of low post-prandial glucose levels in patients having undergone bariatric procedures. While BS is currently the most effective and relatively safe treatment for obesity and its complications, the development of PBH can significantly impact patients' quality of life and mental health. The diagnosis of PBH is still challenging, considering the lack of definitive and reliable diagnostic tools, and the fact that this condition is frequently asymptomatic. However, PBH's prevalence is alarming, involving up to 88% of the post-bariatric population, depending on the diagnostic tool, and this may be underestimated. Given the prevalence of obesity soaring, and an increasing number of bariatric procedures being performed, it is crucial that physicians are skilled to diagnose PBH and promptly treat patients suffering from it. While the milestone of managing this condition is nutritional therapy, growing evidence suggests that old and new pharmacological approaches may be adopted as adjunct therapies for managing this complex condition.
Topics: Humans; Blood Glucose; Quality of Life; Hypoglycemia; Bariatric Surgery; Obesity; Obesity, Morbid; Gastric Bypass
PubMed: 38018334
DOI: 10.1002/dmrr.3750 -
Journal of Clinical Medicine Dec 2023Esophagectomy is a technically complex operation performed for both benign and malignant esophageal disease. Medical and surgical advancements have led to improved... (Review)
Review
Esophagectomy is a technically complex operation performed for both benign and malignant esophageal disease. Medical and surgical advancements have led to improved outcomes in esophagectomy patients over the past several decades; however, surgeons must remain vigilant as complications happen often and can be severe. Post-esophagectomy complications can be grouped into early and late categories. The aim of this review is to discuss the early complications of esophagectomy along with their risk factors, work-up, and management strategies with special attention given to anastomotic leaks.
PubMed: 38137691
DOI: 10.3390/jcm12247622 -
Cureus Nov 2023Bariatric surgery (BS) has emerged as an efficient approach for addressing obesity, offering long-term benefits encompassing substantial weight loss and improving... (Review)
Review
Bariatric surgery (BS) has emerged as an efficient approach for addressing obesity, offering long-term benefits encompassing substantial weight loss and improving metabolic disorders. Many women of childbearing age opt for BS to enhance their health and well-being. The weight loss achieved through these procedures can positively impact pregnancy outcomes, but it's crucial to consider potential drawbacks. Micronutrient deficiencies, such as anemia resulting from iron or vitamin B12 deficiency, are a legitimate concern. Making the decision to have a BS is a complex process with many possible obstacles. The complicated nature of this decision is highlighted by worries about dumping syndrome, surgical complications that could include the risk of internal hernias, and the possibility that infants could be labeled as small for gestational age because of maternal undernourishment. Furthermore, there is a notable absence of international consensus regarding the ideal timing for conceiving after undergoing BS. Therefore, this narrative review extensively explores the existing body of literature, offering insights into the prevailing challenges encountered before and during pregnancy following BS. These challenges encompass a wide range of considerations, commencing with fertility-related issues. The study will cover strategies for addressing vitamin and nutritional deficiencies through supplementation, subtleties of post-BS altered glucose metabolism and how it affects the detection and treatment of gestational diabetes, how dumping syndrome progresses, various surgical problems, and how different bariatric procedures affect pregnancy and fetal outcomes. These include a tendency to give birth to children considered undersized for gestational age, nutritional deficits, anemia, and abnormal maternal glucose metabolism. This review offers a comprehensive exploration of the multifaceted landscape of pregnancy in the context of BS. It aims to provide a valuable resource for healthcare professionals and women considering pregnancy after undergoing BS, enabling them to make well-informed decisions and receive appropriate care during this critical phase of life.
PubMed: 38074055
DOI: 10.7759/cureus.48513 -
Surgical Endoscopy Nov 2023Post-prandial hypoglycemia is an uncommon but disabling late complication of Roux-en-Y gastric bypass (RYGB). Most patients can be treated with dietary interventions and...
BACKGROUND
Post-prandial hypoglycemia is an uncommon but disabling late complication of Roux-en-Y gastric bypass (RYGB). Most patients can be treated with dietary interventions and medications; however, some patients develop refractory hypoglycemia that may lead to multiple daily episodes and seizures. While RYGB reversal surgery is an effective treatment, complication rates are high, and patients inevitably experience weight regain. Transoral gastric outlet reduction (TORe) is a minimally invasive treatment that is effective for early and late dumping syndrome. However, prior studies have not distinguished the effectiveness of TORe specifically for patients with post-prandial hypoglycemia. This study aims to describe a single institution's experience of TORe for treating post-prandial hypoglycemia.
METHODS
This is a case series of patients with prior RYGB complicated by post-prandial hypoglycemia who underwent TORe from February 2020 to September 2021. Pre-procedural characteristics and post-procedural outcomes were obtained. Outcomes assessed included post-prandial hypoglycemia episodes, dumping syndrome symptoms, and weight change.
RESULTS
A total of 11 patients underwent TORe from 2020 to 2021 for post-prandial hypoglycemia. Three (27%) patients had a history of seizures due to hypoglycemia. All had been advised on dietary changes, and ten patients (91%) were on medications for dumping. All patients reported a reduction in post-prandial hypoglycemic events as well as the majority of dumping syndrome symptoms during an average follow-up time of 409 ± 125 days. Ten patients (91%) had experienced weight regain from their post-RYGB nadir weight. For these patients, the average total body weight loss 12 months post-TORe was 12.4 ± 12%. There were no complications requiring hospitalization. One patient experienced post-TORe nausea and vomiting requiring dilation of the gastrojejunal anastomosis with resolution in symptoms.
CONCLUSION
TORe is a safe and effective treatment for post-prandial hypoglycemia and weight regain after RYGB in patients with symptoms refractory to medications and dietary changes.
Topics: Humans; Gastric Bypass; Dumping Syndrome; Treatment Outcome; Hypoglycemia; Reoperation; Seizures; Weight Gain; Obesity, Morbid; Retrospective Studies
PubMed: 37674055
DOI: 10.1007/s00464-023-10389-z -
Obesity Facts 2024Given the lack of research on the relationship of post-surgery dumping syndrome and eating disturbances, the purpose of the present longitudinal study was to investigate...
INTRODUCTION
Given the lack of research on the relationship of post-surgery dumping syndrome and eating disturbances, the purpose of the present longitudinal study was to investigate whether dumping after obesity surgery is associated with pre-/postoperative eating disorder symptoms or addiction-like eating beyond the type of surgery, gender, health-realted quality of life (HRQoL) and anxiety/depressive symptoms.
METHODS
The study included 220 patients (76% women) before (t0) and 6 months after (t1) obesity surgery (sleeve gastrectomy [n = 152], Roux-en-Y gastric bypass [n = 53], omega loop gastric bypass [n = 15]). The Sigstad Dumping Score was used to assess post-surgery dumping syndrome. Participants further answered the Eating Disorder Examination Questionnaire (EDE-Q), Yale Food Addiction Scale 2.0 (YFAS 2.0), Short-Form Health Survey (SF-12), and Hospital Anxiety and Depression Scale (HADS) at t0 and t1.
RESULTS
The point prevalence of symptoms suggestive of post-surgery dumping syndrome was 33%. Regression analyses indicate an association of dumping with surgical procedure (bypass), female gender, reduced HRQoL, more anxiety/depressive symptoms, and potentially with binge eating but not with eating disorder symptoms in general or with addiction-like eating.
CONCLUSION
The current study failed to show a close relationship between the presence of self-reported dumping syndrome and eating disorder symptoms or addiction-like eating following obesity surgery. Further studies with longer follow-up periods should make use of clinical interviews to assess psychosocial variables and of objective measures to diagnose dumping in addition to standardized self-ratings.
Topics: Humans; Female; Male; Dumping Syndrome; Obesity, Morbid; Depression; Longitudinal Studies; Quality of Life; Gastric Bypass; Anxiety
PubMed: 38320543
DOI: 10.1159/000536602 -
Surgical Endoscopy Jun 2024Bariatric surgery has been proven to be the most effective therapy for obesity and Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedure....
Long-term results after transoral outlet reduction (TORe) of the gastrojejunal anastomosis for secondary weight regain and dumping syndrome after Roux-en-Y gastric bypass.
BACKGROUND
Bariatric surgery has been proven to be the most effective therapy for obesity and Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedure. However, weight regain and dumping syndrome occur over time. The transoral outlet reduction (TORe) procedure using an endoscopic suturing device may be an option to treat these conditions. We aimed to analyze outcome parameters and long-term results for this endoscopic technique.
METHODS
A retrospective data analysis of patients who underwent TORe using an endoscopic suturing system at our institution from January 2015 to December 2020 was performed. A total of 71 subjects were included. Forty-five patients received the intervention for weight regain, 9 for dumping syndrome and 17 for both. The primary endpoint was weight stabilization or weight loss for subjects with weight regain, and resolution of symptoms for those with dumping syndrome. Secondary endpoints were intraoperative complications, procedure time, length of hospital stay and diameter of gastrojejunal anastomosis 1 year post-intervention.
RESULTS
The median size of the gastrojejunal anastomosis was estimated at 30 mm before intervention, and after performing a median of 3 endoscopic sutures, the median estimated gastrojejunal anastomosis width was reduced to 9.5 mm. Eight perioperative complications occurred. Overall mean follow-up was 26.5 months. All interventions achieved weight stabilization or weight loss or resolution of dumping symptoms within the first 3 months, 98.2% at 12 months, 91.4% at 24 months and 75.0% at 48 months. In 22/26 subjects a persisting improvement of dumping syndrome was achieved.
CONCLUSIONS
TORe is a safe and effective procedure in the treatment of patients with dumping syndrome after laparoscopic RYGB, the effect on weight stabilization is less significant. A prospective randomized trial should be conducted to compare the effects of TORe with other surgical methods like banding the gastrojejunal anastomosis.
PubMed: 38914888
DOI: 10.1007/s00464-024-10989-3 -
Proximal gastrectomy with double-tract reconstruction is useful in the prevention of glucose spikes.Journal of Gastrointestinal Surgery :... Jun 2024Volatile glucose levels after gastrectomy induce dumping syndrome, which adversely affects patient quality of life. We evaluated the glycemic variability of proximal...
BACKGROUND
Volatile glucose levels after gastrectomy induce dumping syndrome, which adversely affects patient quality of life. We evaluated the glycemic variability of proximal gastrectomy with double-tract reconstruction (PGDT) as a function-preserving procedure.
METHODS
We used a continuous glucose monitoring system (CGM) to record glycemic profiles of patients who had undergone PGDT or total gastrectomy (TG) and compared them. We also evaluated post-gastrectomy syndrome, including dumping symptoms, between the PGDT and TG groups using the 37-item Post-Gastrectomy Syndrome Assessment Scale (PGSAS-37) questionnaire.
RESULTS
Forty-four patients underwent PGDT and 42 underwent TG, which included more advanced cases. CGM results showed that the standard deviation (SD), relative SD, and maximum drop in glucose level between 30minutes and 2hours after a meal were smaller in the PGDT group than TG group (14.81 vs 22.40, p <0.001; 0.143 vs 0.201, p <0.001; and 42.06 vs 117.67mg/dL, p <0.001). For nocturnal glucose levels, SD and percent time below range were smaller in the PGDT group than TG group (11.76 vs 15.16, p=0.005 and 11.25% vs 35.27%, p <0.001). The PGDT group generally performed better than the TG group on the various PGSAS-37 questionnaire items. Patients in the PGDT group with no food inflow into the remnant stomach showed similar CGM results as the TG group but with stronger dumping symptoms.
CONCLUSION
Food inflow into the remnant stomach is essential for PGDT to be a function-preserving procedure as it leads to control of dumping symptoms and lower spikes in glucose.
PubMed: 38878957
DOI: 10.1016/j.gassur.2024.06.012 -
Endocrinology, Diabetes & Metabolism... Jan 2024Dumping syndrome is a rare but potentially serious condition that causes inappropriate postprandial hyperinsulinemia leading to hypoglycemia in children following...
SUMMARY
Dumping syndrome is a rare but potentially serious condition that causes inappropriate postprandial hyperinsulinemia leading to hypoglycemia in children following gastrointestinal surgeries. While dietary modifications are often the first line of treatment, severe cases may require pharmacological intervention to prevent severe hypoglycemia. We present a case of successful treatment of dumping syndrome with diazoxide. A 2-month-old infant with left hypoplastic heart syndrome who underwent single ventricle palliation pathway and developed feeding intolerance that required Nissen fundoplication. Postprandial hypoglycemia was detected following the procedure, with glucose level down to 12 mg/dL, and the diagnosis of dumping syndrome was established. The patient was successfully managed with diazoxide, which effectively resolved postprandial hypoglycemia without any major adverse events. The patient was eventfully weaned off the medication at the age of 5 months. This case highlights the potential role of diazoxide in the management of pediatric patients with postprandial hyperinsulinemic hypoglycemia secondary to dumping syndrome.
LEARNING POINTS
Dumping syndrome is a possible complication of gastrointestinal surgeries and should be suspected in children with abnormal glucose levels. Postprandial hyperglycemia should be monitored closely for significant subsequent hypoglycemia. Diazoxide might be considered as part of the treatment plan for dumping syndrome.
PubMed: 38432066
DOI: 10.1530/EDM-23-0137