Laparoscopic Conversion to Loop Duodenojejunal Bypass with Sleeve Gastrectomy for Intractable Dumping Syndrome After Roux-en-Y Gastric Bypass—Two Case Reports
Open accessAbstract
Background Dumping syndrome is not infrequent after laparoscopic Roux-en-Y gastric bypass (LRYGB) and could result in dreaded complications, such as neuroglycopenia. For those refractory to diet modification or/and medication, regarded as intractable dumping syndrome, revision procedures should be taken into consideration. Herein, we make a video presentation of laparoscopic revision surgery for intractable dumping syndrome with unsatisfactory weight loss. Methods Two diabetic, morbidly obese women (initial body mass index 36.6 and 41.4 kg/m(2)) presented with intractable dumping syndrome 2 and 3 years after initial LRYGB, respectively. In addition, these patients had insufficient weight loss (body mass index 29 and 31 kg/m(2)). Laparoscopic revision procedure of loop duodenojejunal bypass with sleeve gastrectomy was conducted to relieve their intractable conditions. Results The mean operation time was 174 min (160 and 188), and the average blood loss was 60 mL (50 and 70). There was no intraoperative complication. Both patients had uneventful postoperative courses, and the average postoperative hospital stay was 2 days. The uncomfortable symptoms relieved successfully after the revision surgery. The Sigstad's score decreased to 2 points 6 months later, and the body mass index reduced to 26 and 28 kg/m(2). Conclusions Though long-term follow-up is warranted to draw a definite conclusion, loop duodenojejunal bypass with sleeve gastrectomy for pyloric restoration and malabsorptive effect remains an acceptable revision procedure to relive intractable dumping syndrome and successfully maintain sustained weight loss in our patients.
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Various surgical re-interventions have been used, including gastric tube placement, gastric bypass reversal with or without concomitant sleeve resection and gastric pouch restriction.
“Various surgical re-interventions have been used, including gastric tube placement, gastric bypass reversal with or without concomitant sleeve resection and gastric pouch restriction (Table 5) (66,103,105-123).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [112]
The Abstract (p. 1) reports a surgical revision for intractable dumping syndrome after Roux-en-Y gastric bypass: conversion to loop duodenojejunal bypass with sleeve gastrectomy. Our copy does not describe gastric tube placement, bypass reversal with or without sleeve resection, or gastric pouch restriction as the listed alternatives. (LLM, conf=0.82)
Experimental — accuracy not yet measuredApproximately 24% of patients who underwent surgical re-intervention because of refractory severe post-Roux-en-Y gastric bypass hypoglycemia received a gastric bypass reversal and approximately 9% had gastric pouch restriction.
“As shown in Table 5, approximately 24% of patients who underwent surgical re-intervention because of refractory severe post-Roux-en-Y gastric bypass hypoglycemia received a gastric bypass reversal (66,103,106-113) and approximately 9% had gastric pouch restriction (66,114,115).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [112]
The Abstract (p. 1) describes two patients who underwent conversion to loop duodenojejunal bypass with sleeve gastrectomy for intractable dumping syndrome. Searches for gastric bypass reversal, gastric pouch restriction, and the stated percentages found no passage reporting the 24% or 9% figures. The case reports do not establish those proportions among patients undergoing surgical re-intervention. (LLM, conf=0.76)
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Cited by
Sorted by citations
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“(112) Case report N = 2 Laparoscopic conversion to loop duodenojejunal”
BackgroundInternational consensus on the diagnosis and management of dumping syndrome
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“For patients with dumping syndrome resistant to medical treatment or diet modification, surgical revision has been proposed as a beneficial option [44,45].”
BackgroundSingle-Anastomosis Pylorus-Preserving Bariatric Procedures: Review of the Literature
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“[8, 17, 18] – Single-anastomosis duodeno-jejunal bypass with sleeve gastrectomy (SADJB-SG or DJB-SG) proposed by Lee et al.”
MethodBallesteros, G. P. D. L., Romero-Velez, G., Higa, K., Himpens, J. M., O'Kane, M., Torres, A., Prager, G., & Herrera, M. F. (2024) · Obesity Surgery · doi:10.1007/s11695-024-07490-0 · Cited by 26
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“Six months postsurgery, the Sigstad's score decreased to 2 points (85).”
BackgroundChang, P., Huang, C.-K., Tai, C.-M., Huang, I., Hsin, M.-C., & Hung, C.-M. (2017) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2016.09.035 · Cited by 18 · see citing works
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Dumping syndrome : Update on pathophysiology, diagnosis, and management
Tack, J. F., Raymenants, K., de Bruaene, C. V., & Scarpellini, E. (2024) · Neurogastroenterology & Motility · doi:10.1111/nmo.14962 · Cited by 12 · see citing works
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“However, due to the intake of simple carbohydrates, gastroplasty can also lead to several negative impacts such as nausea, vomiting, flushing, epigastric pain, and symptoms of hypoglycemia, also known as the “dumping” syndrome [7].”
BackgroundResultHerbal Medicine for Dumping Syndrome: A Systematic Review and Meta-Analysis
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“LDJB-SG is a good option for revision when intractable dumping syndromes happened after LRYGB (87).”
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Mera-Carreiro, S., Bernaldo-Madrid, B., Rodríguez-Carrillo, C., Esteban-López-Jamar, J. M., Marcuello-Foncillas, C., Pérez-Ferre, N., Ramos-Levi, A. M., Matía-Martín, P., & Rubio-Herrera, M. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1662911
Technical Considerations of Duodenal Switch and Its Variants
Kasama, K., & Palanivelu, P. (2017) · doi:10.1007/978-981-10-2705-5_11
- Authors
- Huang, C.-K., Wang, M.-Y., Das, S. S., & Chang, P.-C.
- Affiliations
- E-Da Hospital (TW)
- Corresponding author
- Chang, Po-Chih
- Venue
- Obesity Surgery
- Published
- 2015-02-24
- Volume
- 25
- Issue
- 5
- Pages
- 947-947
- ISSN
- 0960-8923 (ISSN-L)
- 1708-0428
- OpenAlex
- W2119034215
- Cited by
- 20
- References
- 0
- Citations by year
- 2025: 1 · 2024: 3 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 6 · 2015: 2
- FWCI
- 3.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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 › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- laparoscopic Roux-en-Y gastric bypass
- MeSH terms
- Dumping Syndrome, Duodenum, Female, Humans, Jejunum, Obesity, Morbid, Laparoscopy, Postoperative Complications, Reoperation, Video Recording, Gastric Bypass
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