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World Journal of Clinical Cases Jun 2022Laparoscopic sleeve gastrectomy (LSG) has been proposed as an effective and durable treatment for severe obesity and glucose metabolism disorders, and its prevalence has...
BACKGROUND
Laparoscopic sleeve gastrectomy (LSG) has been proposed as an effective and durable treatment for severe obesity and glucose metabolism disorders, and its prevalence has increased from 5% to 37% since 2008. One common complication after bariatric surgery is a postprandial hyperinsulinemic hypoglycemic state. While rare, insulinomas can cause this state, where symptoms are more common in the fasting state; thus, evaluation of insulin secretion is needed. Until now, there have been no reports of insulinoma after LSG.
CASE SUMMARY
We describe the case of a 43-year-old woman who was referred to the obesity clinic 2 years after LSG was performed. She had symptoms of hypoglycemia predominantly in the fasting state and documented hypoglycemia of less than 30 mg/dL, which are compatible with Whipple's triad. Initially, dumping syndrome was suspected, but after a second low fasting plasma glucose was documented, a 72-h fasting test was performed that tested positive. Computed tomography and endoscopic ultrasound were performed, identifying the presence of a homogeneous hypoechoic semioval tumoral lesion in the pancreas. The diagnosis was compatible with insulinoma. After laparoscopic enucleation of the insulinoma, the symptoms and hypoglycemia disappeared. The histopathological report described a well-differentiated grade 2 neuroendocrine tumor with positive chromogranin and synaptophysin and Ki67 immunopositivity in 4% of the neoplastic cells.
CONCLUSION
Insulinoma after LSG is a rare condition, and clinicians must be aware of it, especially if the patient has hypoglycemic symptoms during the fasting state.
PubMed: 35949856
DOI: 10.12998/wjcc.v10.i18.6227 -
American Family Physician Jun 2022In 2019, approximately 256,000 metabolic surgery procedures were performed in the United States, a 32% increase since 2014. The most common procedures are the...
In 2019, approximately 256,000 metabolic surgery procedures were performed in the United States, a 32% increase since 2014. The most common procedures are the laparoscopic sleeve gastrectomy and the Roux-en-Y gastric bypass. Choice of procedure depends on concurrent medical conditions, patient preference, and expertise of the surgeon. These procedures have a mortality risk of 0.2% to 0.3%. On average, weight loss of 30 to 50 kg (66 to 110 lb), or a 20% to 30% reduction in total body weight, is achieved, although most patients will experience some weight regain three to 10 years after surgery. In patients who have had metabolic surgery, all-cause mortality is reduced by 30% to 45% at two to 15 years postsurgery compared with patients with obesity who did not have surgery. Remission of type 2 diabetes mellitus occurs in as many as 70% to 80% of patients within one to two years after surgery and is maintained at 10 years in about 30% of patients. Other obesity-related conditions are also greatly reduced, and quality of life improves. Postoperatively, patients require standardized nutritional supplementation and surveillance. Persistent changes in diet, such as consuming protein first at every meal, regular physical activity, and ongoing attention to behavior change are critical for the success of the patient after metabolic surgery. Common adverse outcomes include surgical complications, nutritional deficiencies, bone density loss, dumping syndrome, gastroesophageal reflux disease, and loose skin. The family physician is well positioned to counsel patients about metabolic surgical options and the risks and benefits of surgery and to provide long-term support and medical management for postsurgery patients.
Topics: Adult; Bariatric Surgery; Diabetes Mellitus, Type 2; Gastric Bypass; Humans; Laparoscopy; Obesity; Obesity, Morbid; Quality of Life; Retrospective Studies; Treatment Outcome
PubMed: 35704821
DOI: No ID Found -
Obesity Surgery Aug 2022Single-anastomosis sleeve jejunal (SAS-J) bypass is the modification of a single-anastomosis sleeve ileal (SASI) bypass with a short biliary limb. SAS-J bypass is...
PURPOSE
Single-anastomosis sleeve jejunal (SAS-J) bypass is the modification of a single-anastomosis sleeve ileal (SASI) bypass with a short biliary limb. SAS-J bypass is reported to be a good primary bariatric procedure. This study aimed to evaluate the results of SAS-J bypass as a revisional surgery after failed primary restrictive bariatric procedures.
MATERIAL AND METHODS
This was a prospective cohort study including 43 patients who underwent SAS-J bypass as a revisional surgery for weight regain after laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric band (LAGB), or laparoscopic gastric plication.
RESULTS
Of the total patients, 35 (81.4%) were female, and 8 (18.6%) were male. The mean BMI was 46.3 kg/m. The mean age was 41 years. Thirty-two patients (74.4%) had a failed sleeve, 9 (20.9%) had a failed LAGB, and 2 (4.7%) had a failed gastric plication. The mean operative time was 104 min. Intra-abdominal bleeding occurred in 1 case (2.3%), and intraluminal bleeding occurred in 3 cases (7%). No case (0%) developed a leak. The percentage of excess weight loss (%EWL) reached 76.5% after 1 year. Type 2 diabetes mellitus remission occurred in all diabetic patients, hypertension remitted in 80%, hyperlipidemia remitted in 83.3%, and obstructive sleep apnea syndrome improved in all cases. Gastroesophageal reflux disease (GERD) symptoms were improved in 86.7% of patients. Significant biliary gastritis occurred in 4 patients (9.3%). Dumping syndrome was reported in 4 patients (9.3%).
CONCLUSIONS
SAS-J bypass was effective as a salvage surgery after failed restrictive bariatric procedures, but long-term follow-up is needed.
Topics: Adult; Diabetes Mellitus, Type 2; Female; Gastrectomy; Gastric Bypass; Humans; Laparoscopy; Male; Obesity, Morbid; Prospective Studies; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 35665877
DOI: 10.1007/s11695-022-06123-8 -
Cureus Apr 2022Roux-en-Y gastric bypass (RNYGB) has become the standard of care in treating obesity, a global health concern with associated comorbidities contributing to...
Roux-en-Y gastric bypass (RNYGB) has become the standard of care in treating obesity, a global health concern with associated comorbidities contributing to rising health care costs [1]. The positive outcomes of RNYGB have been well documented along with adverse effects such as nutrient deficiencies, hernia, postprandial dumping syndrome, chronic kidney disease and hypoglycemia. A lesser-known long term complication of RNYGB is liver failure. Here, we present a case where RNYGB performed 10 years prior contributed to acute liver failure.
PubMed: 35547455
DOI: 10.7759/cureus.23931 -
Annals of Translational Medicine Mar 2022This study aimed to assess the feasibility, efficacy and safety of McKeown surgery with vagal-sparing using minimally invasive esophagectomy (MIE).
BACKGROUND
This study aimed to assess the feasibility, efficacy and safety of McKeown surgery with vagal-sparing using minimally invasive esophagectomy (MIE).
METHODS
McKeown surgery with vagal-sparing technique using MIE was adopted on patients diagnosed with resectable esophageal cancer. From June 2020 to January 2021, a total of 20 patients from the Department of Thoracic Surgery of the National Clinical Research Center for Cancer were enrolled.
RESULTS
The study group included 17 (85%) males and 3 (15%) females, with an average age of 62.6 (±7.1) years. The most common tumor location was lower thoracic esophagus (n=9, 45%), followed by middle thoracic esophagus (n=8, 40%) and upper thoracic esophagus (n=3, 15%). Nine (45%) patients had T1b disease, followed by T2 (n=8, 40%), T1a (n=2, 10%), and Tis (n=1, 5%). The average operation time was 221.5 (±61.2) minutes. Postoperative complications were as follow: 2 (10%) with hoarseness, 2 (10%) with pulmonary infection, 1 (5%) with arrhythmia, 1 (5%) with anastomotic leakage, 1 (5%) with delayed gastric emptying, 1 (5%) with pleural effusion, and 1 (5%) with diarrhea. Dumping syndrome, cholestasis, and chylothorax were not observed, and there was no perioperative death.
CONCLUSIONS
MIE with vagus nerve preservation is a feasible and safe technique, with the possibility to be an alternative for esophageal carcinoma. Further study is needed to explore the functional outcome of preserving vagus nerve.
PubMed: 35434033
DOI: 10.21037/atm-22-1141 -
Frontiers in Endocrinology 2022Incretin hormones play an important role in the regulation of glucose homeostasis through their actions on the beta cells and other tissues. Glucagon-like peptide-1... (Review)
Review
Incretin hormones play an important role in the regulation of glucose homeostasis through their actions on the beta cells and other tissues. Glucagon-like peptide-1 (GLP-1) and glucose dependent insulinotropic polypeptide (GIP) are the two main incretins and are secreted by enteroendocrine L- and K-cells, respectively. New evidence suggests that incretin hormones, particularly GLP-1, play a role in the pathophysiology of hyperinsulinemic hypoglycemia. In individuals with acquired hyperinsulinemic hypoglycemia after gastrointestinal surgery, including Nissen fundoplication and gastric bypass surgery, the incretin response to a meal is markedly increased and antagonism of the GLP-1 receptor prevents the hyperinsulinemic response. In individuals with congenital hyperinsulinism due to inactivating mutations in the genes encoding the beta cell K channels, the GLP-1 receptor antagonist, exendin-(9-39), increases fasting plasma glucose and prevents protein-induced hypoglycemia. Studies in human and mouse islets lacking functional K channels have demonstrated that the effect on plasma glucose is at least in part mediated by inhibition of insulin secretion resulting from lower cytoplasmic cAMP levels. The understanding of the role of incretin hormones in the pathophysiology of hyperinsulinemic hypoglycemia is important for the exploration of the GLP-1 receptor as a therapeutic target for these conditions. In this article, we will review incretin physiology and evidence supporting a role of the incretin hormones in the pathophysiology of hyperinsulinemic hypoglycemia, as well as results from proof-of concept studies exploring a therapeutic approach targeting the GLP-1 receptor to treat hyperinsulinemic hypoglycemia.
Topics: Adenosine Triphosphate; Blood Glucose; Congenital Hyperinsulinism; Gastric Inhibitory Polypeptide; Glucagon-Like Peptide 1; Glucagon-Like Peptide-1 Receptor; Incretins
PubMed: 35399928
DOI: 10.3389/fendo.2022.863184 -
Journal of Healthcare Engineering 2022The aim of this study was to investigate the effects of double-channel anastomosis versus esophagojejunostomy on postoperative recovery and complications after...
Effect of Double-Channel Anastomosis and Esophagojejunal Anastomosis on Postoperative Recovery and Complications of Laparoscopic D2 Radical Gastrectomy for Gastric Cancer.
The aim of this study was to investigate the effects of double-channel anastomosis versus esophagojejunostomy on postoperative recovery and complications after laparoscopic D2 radical gastrectomy for early proximal gastric cancer. The cases were collected from 100 patients with early proximal gastric cancer admitted to our hospital from January 2017 to January 2021. According to different surgical methods, they were divided into control group (total gastrectomy + esophagojejunal anastomosis) and experimental group (D2 radical resection + double-channel anastomosis). The two groups were compared in terms of clinical outcomes (operative time, intraoperative blood loss, number of lymph nodes dissected, digestive tract anastomosis time, postoperative exhaust, and hospitalization days), postoperative complications, and nutritional status; the expression of T lymphocyte subsets in peripheral blood of the two groups was detected to reflect the recovery of immune ability. There was no significant difference between the observation group and the control group in clinical operation effect indexes ( < 0.05). The incidence of complications of dumping syndrome and reflux esophagitis in the observation group was significantly lower than that in the control group ( < 0.05). In terms of postoperative nutritional status, the ratio of plasma albumin level and body weight restored to operation at 12 and 24 weeks after operation in the observation group was significantly higher than that in the control group ( < 0.05). 3 months after the operation, the levels of CD3 +, CD4 + cell subsets, and CD4+/CD8+ index reflecting the recovery of immune ability in the observation group were significantly higher than those in the observation group ( < 0.05). The application of double-channel anastomosis in laparoscopic D2 radical gastrectomy for early proximal gastric cancer has a better effect on reducing complications and promoting postoperative recovery, which is of great application value.
Topics: Anastomosis, Surgical; Gastrectomy; Humans; Laparoscopy; Retrospective Studies; Stomach Neoplasms
PubMed: 35368937
DOI: 10.1155/2022/8281558 -
World Journal of Gastrointestinal... Feb 2022For total laparoscopic distal gastrectomies for gastric cancer, the reconstruction method is critical to the clinical outcome of the procedure. However, which...
BACKGROUND
For total laparoscopic distal gastrectomies for gastric cancer, the reconstruction method is critical to the clinical outcome of the procedure. However, which reconstruction technique is optimal remains controversial. We originally reported the augmented rectangle technique (ART) as a reconstruction option for total laparoscopic Billroth I reconstructions. Still, little is known about its effect on long-term outcomes, specifically the incidence of postgastrectomy syndrome and its impact on quality of life.
AIM
To analyze postgastrectomy syndrome and quality of life after ART using the Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37) questionnaire.
METHODS
At Juntendo University, a total of 94 patients who underwent ART for Billroth I reconstruction with total laparoscopic distal gastrectomies for gastric cancer between July 2016 and March 2020 completed the PGSAS-37 questionnaire. Multidimensional analysis was performed, comparing those 94 ART cases from our institution (ART group) to 909 distal gastrectomy cases with a Billroth I reconstruction from other Japanese institutions who also completed the PGSAS-37 as part of a larger national database (PGSAS group).
RESULTS
Patients in the ART group had significantly better total symptom scores in all the symptom subscales (, esophageal reflux, abdominal pain, meal-related distress, indigestion, diarrhea, constipation, and dumping). The loss of body weight was marginally greater for those in the ART group than in the PGSAS group (-9.3% -7.9%, = 0.054). The ART group scored significantly lower in their dissatisfaction of ongoing symptoms, during meals, and with daily life.
CONCLUSION
ART for Billroth I reconstruction provided beneficial long-term results for postgastrectomy syndrome and quality of life in patients undergoing total laparoscopic distal gastrectomies for gastric cancer.
PubMed: 35317549
DOI: 10.4240/wjgs.v14.i2.120 -
Annals of Surgery Open : Perspectives... Mar 2022Late dumping syndrome is a common postgastrectomy complication characterized by reactive hypoglycemia. This study aimed to explore the glycemic trend in patients who...
OBJECTIVE
Late dumping syndrome is a common postgastrectomy complication characterized by reactive hypoglycemia. This study aimed to explore the glycemic trend in patients who underwent gastrectomy for gastric cancer and clarify its changes over time in association with postgastrectomy symptoms.
SUMMARY BACKGROUND DATA
Changes over time in glycemic trend in association with postgastrectomy symptoms have not been evaluated.
METHODS
We conducted a prospective study of 71 patients who underwent curative gastrectomy for gastric cancer between November 2017 and April 2020. The patients underwent continuous glucose monitoring twice-at 1- and 12-month postgastrectomy-and were assessed using the Post-Gastrectomy Syndrome Assessment Scale 37-item questionnaire (PGSAS-37) at 1-, 6-, and 12-month postgastrectomy.
RESULTS
Our results revealed that hypoglycemia (<70 mg/dL), especially nocturnal hypoglycemia (00:00-06:00), frequently occurred even at 12-month postgastrectomy. Hypoglycemia improved in total gastrectomy patients but remained unchanged in distal gastrectomy patients, which was still high in both groups at 12-month postgastrectomy. Glycemic variability (SD of the glycemic trend) was exacerbated in both gastrectomy groups. However, the PGSAS-37 symptom scores remained unchanged, and the living status and quality of life tended to improve. Hypoglycemia unawareness, including postprandial hypoglycemia without symptoms and nocturnal hypoglycemia, was evident even 12-month postgastrectomy.
CONCLUSIONS
Persistent postgastrectomy hypoglycemia unawareness, including late dumping syndrome without symptoms and nocturnal hypoglycemia, should be recognized as an important issue in postgastrectomy syndrome. Therefore, meticulous long-term evaluation for glycemic trends and care of patients is required.
PubMed: 37600103
DOI: 10.1097/AS9.0000000000000135 -
Clinical Case Reports Feb 2022Insulinomas are uncommon neuroendocrine tumors and metastatic disease is extremely rare. We report a patient with metastatic insulinoma associated with multiple...
Insulinomas are uncommon neuroendocrine tumors and metastatic disease is extremely rare. We report a patient with metastatic insulinoma associated with multiple endocrine neoplasia type 1 presenting with hypoglycemia following sleeve gastrectomy. Potential causes of hypoglycemia include dumping syndrome, noninsulinoma pancreatogenous hypoglycemia syndrome, and rarely insulinoma. MEN1-associated insulinomas have a higher recurrence rate.
PubMed: 35145695
DOI: 10.1002/ccr3.5419