Some improvements in the technique of creating an "artificial stomach" from the small intestine in partial and total resections of the stomach

The literature of recent decades about the long-term consequences of partial and total resections of the stomach clearly indicates that a significant part of patients after these operations have persistent digestive disorders. The developing peculiar complex symptom complex is designated by various names: "agastral asthenia" (A. A. Busalov, M. S. Govorova), "resection disease" (G. G. Karavanov and O. V. Filts), "hyperglycemic syndrome" (OL Gordon), "hypoglycemic syndrome"; in foreign literature, the term "dumping syndrome" or "postgastrectomy syndrome" is often used.

Management of Late Dumping Syndrome Induced Hypoglycemia With GLP-1R Agonist

Background: Late dumping syndrome is a prominent post-bariatric surgery side effect. Glucose-dependenthyperinsulinemia, induced by elevated gastric inhibitory polypeptide (GIP) and glucagon-likepeptide-1 (GLP-1) levels, leading to 2–3 hours post-prandial hypoglycemia. In literature, several managements are available: dietary changes, glucosidase inhibitor, andsomatostatin analogues. In case of failure of those strategies, partial or total pancreatectomy isindicated. Recently, management using GLP-1R agonists showed promising effect inmanagement of late dumping syndrome induced post-prandial hypoglycemia. (1)AimThe aim of this study was to investigate the effect of using GLP-1R agonists w/o low glycemicindex diet for treating dumping syndromes induced post-prandial hypoglycemia in post bariatricsurgery patients. Methods: A sample of 27 cases (25 females, 2 males) mean age 44.64, SD 10.2 of post-bariatric surgerywere managed using GLP-1R w/o low-glycemic index diet after being diagnosed with the latedumping syndrome induced post-prandial hypoglycemia for duration 1–3 years post-surgery. The27 were sent a survey of 13 questions related to their experience pre-and post-management plan. Results: Out of the 27 patients, 15 responded to the survey. The results showed 100% of the participantsdeveloped episodes of severe symptomatic late dumping syndrome with hypoglycemiasymptoms diagnosed after one and half years of their symptoms. 87% of them experiencedhypoglycemia post meals 2–3 hours.70 % of the participants got hypoglycemia more than 5episodes per week (less than 4.0 mmol/l) which was confirmed by blood glucose monitoring. After starting treatment with GLP-1R agonists with or without low-glycemic index diet, 87% ofthe participants reported that the hypoglycemia episodes were reduced. Out of those 87%participants 46% did not get any hypoglycemia episode and 54% of them experienced 1–2 timeshypoglycemia episodes. Conclusion: The results of the survey showed the successful reduction or prevention of late dumpinghypoglycemia episodes frequency post-bariatric surgery by GLP 1R agonist with or without lowglycemicindex diet. References: Non, A.N.H.W.H. and Black, H., 2012. Scope of the Problem. Am J Prev Med, 42, pp.563–70.Chiappetta, S. and Stier, C., 2017. A case report: Liraglutide as a novel treatment option in late dumping syndrome. Medicine, 96(12).

Hypoglycemia after bariatric surgery: importance of exhaustive hormonal study

Summary Hypoglycemia is an uncommon clinical problem in non-diabetic patients or patients not being treated for diabetes mellitus. It is a rare, but well-established complication of bariatric surgery and, in some cases, it can be the only symptom of another medical problem. A 50-year-old woman with a history of partially recovered hypopituitarism after transsphenoidal surgery for a non-functioning pituitary macroadenoma complained about symptomatic hypoglycemia after sleeve gastrectomy surgery. Our initial studies failed to determine the cause for these episodes and treatment with acarbose (suspecting a dumping syndrome) was not helpful. Finally, laboratory findings revealed growth hormone (GH) deficiency. The patient received treatment with GH, with the resolution of symptoms after 3 months of treatment. Our case suggests that all causes of hypoglycemia should be considered and studied after bariatric surgery. An improvement in insulin-resistance following bariatric surgery can trigger clinical manifestations of GH deficiency. Learning points Postprandial hypoglycemia after bariatric surgery is usually due to dumping syndrome. Even after bariatric surgery, all causes of hypoglycemia should be considered and studied. After significant weight loss, insulin sensitivity is usually restored and can trigger clinical manifestations of GH deficiency. Hypoglycemia is a rare symptom of GH deficiency.

Incidence of Dumping Syndrome after Sleeve Gastrectomy, Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass

Background: Dumping syndrome (DS) is an important but often missed problem occurring after bariatric surgery. It is believed that gastric bypass procedures like Roux-en-Y Gastric Bypass (RYGB) and One-Anastomosis Gastric Bypass (OAGB) are more likely to cause DS than the pylorus-preserving Sleeve Gastrectomy (SG). The aim of this study was to evaluate the incidence of DS in patients undergoing SG, RYGB and OAGB. Methods: A retrospective clinical study with additional phone interviews of 180 morbidly obese patients (130 females; 72.2%) undergoing SG (n=50), RYGB (n=53) and OAGB (n=77) in our clinic during 2016 - 2018 was performed. Clinical and demographic data were assessed. The incidence of dumping syndrome was evaluated using validated Sigstad Score. Results: Information about the occurrence of dumping symptoms and patient satisfaction was obtained from 127 patients; 53 could not be reached by phone. Median follow-up was 20.0 ± 11.4 months. Significant differences between the surgical procedures were found for the duration of surgery, complications, incidence of DS and satisfaction postoperatively. DS occurred in 15.6% after SG, in 56.4% after RYGB and in 42.9% after OAGB. While SG showed the shortest operative time with 66.5 ± 25.3 minutes and highest patient satisfaction, the lowest complication rate was observed after OAGB with 5.2%. The RYGB group reported the longest duration of surgery with 121.0 ± 28.9 minutes, most complications (17.0%), and lowest patient satisfaction. Conclusion: The present results showed a clear superiority of SG regarding both perioperative results and incidence of DS compared to RYGB and OAGB and may impact clinicians and patients in their choice of procedure.