The DOI matches its Crossref record; 37 of the 37 references it cites were found in a registry or an index.
Severe Recurrent Hypoglycemia after Gastric Bypass Surgery
Abstract
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…
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“Pancreatic resection, the most commonly reported procedure, was performed in approximately 67% of patients (66,103,105,107,114,116-123).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [114]
In the citing paper
“Silastic ring or gastric band placement to delay nutrient transit led to hypoglycemia resolution in 92% of patients in a small case series [70].”
From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [70]
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Hu, S., Tang, H., Wang, H.-X., Dong, Z.-Y., Jiang, S.-W., Wang, C.-C., Chen, X., & Yang, W. (2020) · Journal of metabolic and bariatric surgery · doi:10.17476/jmbs.2020.9.1.1 · Cited by 7
“[42] use a silastic ring to place under the anastomotic stoma.”
MethodHasan, M. A., Schwartz, S. S., McKenna, V., & Ing, R. (2023) · Obesity Surgery · doi:10.1007/s11695-023-06758-1 · Cited by 7
“[102] reported the use of a gastric band or silastic ring to reduce the pouch diameter in 12 patients presenting with hypoglycemia [102].”
BackgroundInfluentialEidy, M., Jesmi, F., Raygan, F., Pishgahroudsari, M., & Pazouki, A. (2015) · Bariatric Surgical Practice and Patient Care · doi:10.1089/bari.2014.0032 · Cited by 8
Hyperinsulinemic hypoglycemia and liver cirrhosis presenting after duodenal switch: a case report.
Aasheim, E., Frigstad, S., Søvik, T. T., Birkeland, K., & Haukeland, J. W. (2010) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2009.11.007 · Cited by 9
Kubota, T., Yubakami, M., Ushigome, E., Ohashi, T., Shoda, K., Konishi, H., Shiozaki, A., Fujiwara, H., Okamoto, K. K., Fukui, M., et al. (2022) · Annals of Surgery Open · doi:10.1097/as9.0000000000000135 · Cited by 7
Recommendations for the diagnosis and treatment of hypoglycaemia after bariatric surgery
Vilarrasa, N., Lesmes, I. B., Ballesteros-Pomar, M. D., Lecube, A., Goday, A., Pellitero, S., Sánchez‐Santos, R., Zugasti, A., Ciudin, A., de Hollanda, A., et al. (2022) · Endocrinología Diabetes y Nutrición (English ed ) · doi:10.1016/j.endien.2021.09.005 · Cited by 7
Total Pancreatectomy for the Management of Refractory Post-Gastric Bypass Hypoglycemia
Spolverato, G., Bhaijee, F., Anders, R. A., Salley, K. E. S., Parambi, J., Brown, T. T., & Pawlik, T. M. (2014) · Digestive Diseases and Sciences · doi:10.1007/s10620-014-3408-8 · Cited by 7
“Post-surgical weight loss improves the comorbidities related to severe obesity and increases the quality of life while reducing overall obesity-related mortality [8].”
BackgroundSabah, S. A., Haddad, E. A., Qadhi, I., AlMuhaini, M., AlAwtan, A., AlQabandi, O. A., Alkhayat, A., Saleem, A. F., & Behbehani, M. (2025) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-025-03680-1 · Cited by 5
“Studies have shown that revision to RYGB significantly improves or resolves hypoglycemia in most patients, making it a clinically justified option when conservative measures (e.g., dietary changes, medications) fail [ 27 , 28].”
Dumping Syndrome After One Anastomosis Gastric Bypass—A Systematic Review
Kermansaravi, M., Shahsavan, M., Amr, B., Stier, C. K., Parmar, C. D., & Chiappetta, S. (2025) · Obesity Surgery · doi:10.1007/s11695-025-07860-2 · Cited by 5
“Other measures include surgical placement of a silastic ring or band [48] and reversal surgeries in severe cases who failed all non-surgical options [2, 32, 49].”
Then, C., Nam‐Apostolopoulos, Y., Seißler, J., & Lechner, A. (2012) · PubMed · doi:10.6092/1590-8577/1319 · Cited by 5
Parsaik, A. K., Carter, R. E., Myers, L. A., Dong, M., Basu, A., & Kudva, Y. C. (2012) · Journal of Diabetes Science and Technology · doi:10.1177/193229681200600515 · Cited by 5
Hypoglycemia and Hypoglycemic Syndromes
Davis, S. N., Lamos, E. M., & Younk, L. M. (2015) · Elsevier eBooks · doi:10.1016/b978-0-323-18907-1.00047-0 · Cited by 5
Seyfried, F., Wierlemann, A., Bala, M., Faßnacht, M., & Jurowich, C. F. (2015) · Der Chirurg · doi:10.1007/s00104-015-0047-3 · Cited by 9
Tsai, C., Dimou, M., Naef, M., Steffen, R., Zehetner, J., Nakas, C. T., & Bally, L. (2022) · Surgical Endoscopy · doi:10.1007/s00464-021-08952-7 · Cited by 4
“Both patients reported loss of restriction complicated by hyperinsulinemic hypoglycemia, thus restoration of restriction was indicated and consisted of pouch downsizing and a new Fobi band placement [18].”
BackgroundSelf-citationBack to Sleeve: an Extreme Solution for Specific Complications of the Roux-en-Y Gastric Bypass
Schneck, A., Stenard, F., & Iannelli, A. (2015) · Obesity Surgery · doi:10.1007/s11695-015-1770-z · Cited by 4
Post-Bariatric Surgery Hypoglycemia
Bantle, J. P. (2016) · The Endocrine Society eBooks · doi:10.1210/mtp5.9781943550043.ch43 · Cited by 3
Effects of gastric bypass on FoxO1 expression in the liver and pancreas of diabetic rats
Chen, Z., Meng, C., Liu, J., Zhang, J., Kou, Y., Zhang, L., & Wang, Z. (2016) · Endocrine Research · doi:10.3109/07435800.2015.1044010 · Cited by 3
“Pancreatic islet cell hyperplasia has been rarely observed in patients who undergo GBS (30,31).”
BackgroundFelsenreich, D. M., Prager, G., Chiappetta, S., & Stier, C. K. (2023) · Obesity Surgery · doi:10.1007/s11695-023-06814-w · Cited by 2
Les complications de la chirurgie bariatrique
Emungania, O. (2010) · Springer eBooks · doi:10.1007/978-2-8178-0097-4_7 · Cited by 2
“Dans une série, 11 patients sur 12 ont pu être traités par cette méthode [78].”
Postprandial Hyperinsulinemic Hypoglycemia in Bariatric Surgery
de Heide, L. J. M., Emous, M., & van Beek, A. P. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-804011-9.00054-6 · Cited by 2
Hypoglycemia after Roux-en-Y gastric bypass surgery
Molina, M., García, J., Civera, M., Ortega, J., Martínez-Valls, J. F., Martínez‐Hervás, S., Real, J. T., & Carmena, R. (2011) · Endocrinología y Nutrición (English Edition) · doi:10.1016/s2173-5093(11)70044-7 · Cited by 2
Hypoglycemia in Pancreatic Disease
Mordes, M. J. T. A. J. P. (2015) · doi:10.3998/panc.2015.11 · Cited by 2
“Surgical approaches to the problem have included gastric banding, based on the hypothesis that some cases are due “late severe dumping syndrome” (43).”
BackgroundInfluentialHypoglycémies réactionnelles ou fonctionnelles
Slama, G. (2011) · Médecine des Maladies Métaboliques · doi:10.1016/s1957-2557(11)70268-1 · Cited by 1
Metadata
- Authors
- Z’graggen, K., Guweidhi, A., Steffen, R., Potoczna, N., Biral, R., Walther, F., Komminoth, P., & Horber, F.
- Affiliations
- Triemli Hospital (CH)
- Corresponding author
- Horber, Fritz
- Venue
- Obesity Surgery
- Published
- 2008-04-26
- Volume
- 18
- Issue
- 8
- Pages
- 981-988
- ISSN
- 0960-8923 (ISSN-L)
- 1708-0428
- OpenAlex
- W2055803430
- Cited by
- 125
- References
- 37
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 10 · 2022: 6 · 2021: 3 · 2020: 7 · 2019: 6 · 2018: 1 · 2017: 6 · 2016: 10 · 2015: 8 · 2014: 10 · 2013: 11 · 2012: 5
- FWCI
- 11.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Obesity Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
- Keywords
- recurrent hypoglycemia, gastric bypass
- MeSH terms
- Adult, Dumping Syndrome, Female, Follow-Up Studies, Humans, Hypoglycemia, Male, Middle Aged, Obesity, Morbid, Pancreatectomy, Laparoscopy, Recurrence, Severity of Illness Index, Gastric Bypass
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