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]
Citations
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Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., Heinberg, L. J., Kushner, R., Adams, T. D., Shikora, S., et al. (2013) · Obesity · doi:10.1002/oby.20461 · Cited by 1,650
“[336] Z’graggen K, Guweidhi A, Steffen R, et al.”
Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., Heinberg, L. J., Kushner, R. F., Adams, T. D., Shikora, S. A., et al. (2013) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2012.12.010 · Cited by 715
“[336] Z’graggen K, Guweidhi A, Steffen R, et al.”
Hormonal and Metabolic Mechanisms of Diabetes Remission after Gastrointestinal Surgery
Thaler, J. P., & Cummings, D. E. (2009) · Endocrinology · doi:10.1210/en.2009-0367 · Cited by 443
Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., Heinberg, L. J., Kushner, R., Adams, T. D., Shikora, S., et al. (2013) · Endocrine Practice · doi:10.4158/ep12437.gl · Cited by 395
Metabolic Surgery to Treat Type 2 Diabetes: Clinical Outcomes and Mechanisms of Action
Rubino, F., Schauer, P. R., Kaplan, L. M., & Cummings, D. E. (2010) · Annual Review of Medicine · doi:10.1146/annurev.med.051308.105148 · Cited by 391
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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