One-Anastomosis Jejunal Interposition with Gastric Remnant Resection (Branco-Zorron Switch) for Severe Recurrent Hyperinsulinemic Hypoglycemia after Gastric Bypass for Morbid Obesity
| Autor: | Alcides Branco, Gyurdzhan Rasim, Ricardo Zorron, Johann Pratschke, T Junghans, Jose Sampaio, C Bothe, Safak Guel-Klein |
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| Rok vydání: | 2016 |
| Předmět: |
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medicine.medical_specialty Endocrinology Diabetes and Metabolism medicine.medical_treatment Gastric Bypass 030209 endocrinology & metabolism Pilot Projects Anastomosis Hypoglycemia medicine.disease_cause 03 medical and health sciences 0302 clinical medicine Weight loss Gastrectomy Recurrence Hyperinsulinism Gastric Stump medicine Humans Hyperinsulinemic hypoglycemia Antrum Laparotomy Nutrition and Dietetics business.industry General surgery Neuroglycopenia Anastomosis Surgical Middle Aged Pylorus medicine.disease Surgery Obesity Morbid medicine.anatomical_structure Jejunum Pancreatectomy Chronic Disease 030211 gastroenterology & hepatology Female medicine.symptom business |
| Zdroj: | Obesity surgery. 27(4) |
| ISSN: | 1708-0428 |
| Popis: | The anatomical and physiological changes after Roux-en-Y gastric bypass for morbid obesity can lead to severe hyperinsulinemic hypoglycemia with neuroglycopenia in a small percentage of patients. The exact physiologic mechanism is not completely understood. Surgical reversal to the original anatomy and distal or total pancreatectomy are current therapeutic options to reverse the hypoglycemic effect, with substantial associated morbidity. Our group reports a pilot clinical series of a novel surgical technique using one-anastomosis jejunal interposition with gastric remnant resection (Branco-Zorron Switch). Patients with severe symptomatic hyperinsulinemic hypoglycemia refractory to conservative therapy were treated using the technique. The procedure started with resection of the remnant stomach close to pylorus. The alimentary limb was sectioned at 20 cm from the gastrojejunal anastomosis, and the rest of the alimentary limb was resected until the Y-Roux anastomosis. A hand-sutured anastomosis was then performed with the proximal alimentary limb and the remnant antrum. Four patients were successfully submitted to the procedure with reversal of the symptomatology and normalization of insulin levels, postprandial glucose levels, and oral glucose tolerance test, with a mean follow-up of 24.3 months. Mean operative time was 188 min, and patients recovered without postoperative complications. Patients suffering from severe hyperinsulinemic hypoglycemia after gastric bypass may be efficiently treated by this innovative procedure, avoiding extreme surgical therapy such as pancreatectomy or restoring the gastric anatomy, while still maintaining sustained weight loss. Studies with larger series and longer follow-up are still needed to define the role of this therapy in managing this entity. |
| Databáze: | OpenAIRE |
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