Severe recurrent hypoglycemia after gastric bypass surgery
Severe recurrent hypoglycemia after gastric bypass surgery
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DOI：
10.1007/s11695-008-9480-4
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发表时间：
2008-08-01
期刊：
影响因子：
2.9
通讯作者：
Horber, Fritz
中科院分区：
文献类型：
--
作者：
Z'graggen, Kaspar;Guweidhi, Ahmed;Horber, Fritz
背景 减肥手术是目前严重肥胖患者实现长期大幅减肥的最有效方法。最近，在一小部分严重肥胖患者中，胃绕道手术（GBS）导致了严重的复发性症状性高胰岛素性低血糖。胰腺成纤维细胞增多症（一种胰岛细胞增生）被认为是病因，建议治疗为次全或全胰腺切除术。方法我们观察到，GBS 后严重的致残性低血糖仅发生在失去限制的患者中。恢复胃限制是否可以治疗 GBS 后严重的、复发性低血糖尚不清楚。 结果 因此，在 12 名连续出现严重低血糖（血糖低于 2.2 mM）的患者中，通过在胃袋周围手术放置硅橡胶环（n = 8，前两名患者进行了额外的远端胰腺切除术）或可调节胃带（n = 4）来恢复胃限制。在恢复胃限制后的随访中（中位随访7个月，范围5至19个月），11名患者没有表现出低血糖发作，而1名患者出现低血糖复发并接受了远端胰腺切除术。手术死亡率为0%，发病率为8.3%。结论 GBS 后患有严重复发性低血糖的患者在大多数情况下只需恢复胃限制即可得到治疗。远端胰腺切除术应被视为二线治疗。
Background Bariatric surgery is, at present, the most effective method to achieve major, long-term weight loss in severely obese patients. Recently, severe recurrent symptomatic hyperinsulinemic hypoglycemia was described as a consequence of gastric bypass Surgery (GBS) in a small series of patients with severe obesity. Pancreatic nesidioblastosis, a hyperplasia of islet cells, was Postulated to be the cause, and subtotal or total pancreatectomy was the Suggested treatment.Methods We observed that severe, disabling hypoglycemia after GBS occurred only in patients with loss of restriction. Whether restoration of gastric restriction might treat severe, recurrent hypoglycemia after GBS is unknown.Results Therefore, gastric restriction was restored by surgical placement of a silastic ring (n=8, first two patients with additional distal pancreatectomy) or an adjustable gastric band (n=4) around the pouch in 12 consecutive patients presenting with severe hypoglycemia (blood glucose below 2.2 mM). At follow-up after restoration of gastric restriction (median follow-up 7 months, range 5 to 19 months), 11 patients demonstrated no hypoglycemic episodes, while one had recurrence of hypoglycemia and underwent distal pancreatectomy. procedural mortality was 0% and morbidity 8.3%.Conclusion Patients suffering from severe recurrent hypoglycemia after GBS can be treated, in most cases, just by restoration of gastric restriction. Distal pancreatectomy should be considered a second-line treatment.