Postprandial hyperinsulinemic hypoglycemia after gastric bypass surgical treatment
Abstract
An association between post-Roux-en-Y gastric bypass (RYGB) hypoglycemia and nesidioblastosis was reported in 2005 and may cause serious neuroglycopenic symptoms. Most patients with postprandial hypoglycemia after RYGB respond to nutritional and medical treatment. A subset of patients, however, may not respond adequately and surgery may be considered. This review describes the current experience with surgical intervention for severe post-RYGB hypoglycemia. PubMed and MEDLINE searches were made for reports describing clinical outcome after such surgery. Fourteen papers including 75 patients were identified. Different surgical interventions were applied including gastric tube placement, reversal of the bypass with and without concomitant sleeve resection, gastric pouch restriction, and pancreatic resection and reresection. Pancreatic resection was performed in 51 (68%) patients, 17 (23%) had RYGB reversal and eleven (15%) had gastric pouch restriction alone. Eight (11%) patients received 2 or more consecutive procedures for hypoglycemia and combined interventions were made in several patients. Resolution of the symptoms occurred in 34/51 (67%) patients after pancreatic resection, 13/17 (76%) after reversal, and 9/11 (82%) after pouch restriction. Mean follow up, however, was short for most series and the methods applied for evaluation of hypoglycemia varied. Weight regain, diabetes and recurrent symptoms were late complications. The optimal therapy for hypoglycemia after RYGB i…
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There is an association between hypoglycemia after Roux-en-Y gastric bypass and nesidioblastosis that may result in serious and refractory neuroglycopenic symptoms, which respond to pancreatic resection and re-re section.
“A special consideration is the association between hypoglycemia after Roux-en-Y gastric bypass and nesidioblastosis that may result in serious and refractory neuroglycopenic symptoms, which respond to pancreatic resection and re-re section (124).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [124]
RYGB reversal has a success rate of 76%.
“RYGB reversal has a success rate of 76% [71].”
From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [71]
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“Hypoglycemia associated with excessive insulin secretion, has been reported after GBP, and has been attributed to nesidiobastosis [28, 29], possibly mediated by the effect of GLP-1 on the pancreas.”
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“45,46 By 2024, the guidelines introduced a less invasivesurgical option, such asgastrostomy tube placement in the remnant stomach, allowing for controlled feeding into the remnant stomach, bypassing the hyperactive jejunal response to food that characterizes PBH. 47 Gastrostomy tube placement may…”
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“described an exhaustive list of all surgical procedures that have been performed and published, including gastric tube placement, reversal of the RYGB with or without concomitant sleeve resection, gastric pouch restriction and pancreatic resection [10].”
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Vilarrasa, N., Bretón, I., Ballesteros-Pomar, M., Lecube, A., Goday, A., Pellitero, S., Sánchez, R., Zugasti, A., Ciudin, A., de Hollanda, A., et al. (2021) · Endocrinología Diabetes y Nutrición · doi:10.1016/j.endinu.2021.09.003 · Cited by 1 · see citing works
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“About 96.2% of experts agreed that, in cases of severe hypoglycemia refractory to dietary and pharmacologic management, revision surgical strategies may be considered 122 .”
InfluentialSundrum, L., Finze, A., Otto, M., Betzler, J., Schölch, S., Hetjens, S., Reissfelder, C., Blank, S., & Stier, C. K. (2026) · Visceral Medicine · doi:10.1159/000552820
“In contrast, for severe or refractory DS, surgical approaches such as pancreatectomy have largely been abandoned in favor of less invasive alternatives [20, 21].”
Nakib, C. E., Ewidat, O., Mayaleh, M. A. A., Riyad, N., Shared, S., & Kanani, F. (2026) · International journal of surgery case reports · doi:10.1097/rc9.0000000000000515
“Because PHH often develops beyond the first postoperative year, a 3-month follow-up is insufficient to adequately assess long-term efficacy, nutritional risks, weight regain, or the potential for PHH recurrence [ 14 ] .”
Reversión del Bypass Gástrico: Indicaciones y Resultados Quirúrgicos.
Pimentel, N. B., Gajardo, P. P. S., Tirado, P. A., Sanhueza, N. Q., Echavarria, A. R., Eulufi, F. C., Blanco, G. P., Martínez, R. M., Nervi, M. G., Lobos, J. K., et al. (2020) · Revista de cirugía · doi:10.35687/s2452-45492021005908
“La mediana de edad y del tiempo transcurrido desde la cirugía primaria hasta la reversión fue de 55 años (46-63) y de 77 meses (10-132), respectivamente.”
BackgroundHIPOGLUCEMIA HIPERINSULINÉMICA POSTPRANDIAL LUEGO DE LA CIRUGÍA BARIÁTRICA
Álvarez, M. G., Gutt, S., Yuma, M., Polo, P., González, S., Menéndez, E., Vanoli, G., Montemerlo, H., Ackerman, M., Coronel, J., et al. (2019) · Revista de la Sociedad Argentina de Diabetes · doi:10.47196/diab.v53i1.137
Nesidioblastosis del adulto tras derivación gástrica
López, V., Builes-Barrera, C., Osorio, G., Morales, C., Toro, J., & Román-Gónzález, A. (2017) · Revista Colombiana de Cirugía · doi:10.30944/20117582.40
POST–GASTRIC BYPASS HYPOGLYCEMIA IN A PATIENT WITH END-STAGE RENAL DISEASE
Gutman, D. S., & Eisenberg, Y. (2017) · AACE Clinical Case Reports · doi:10.4158/ep161467.cr
Serra, F. (2022) · Revista de la Sociedad Española de Cirugía de Obesidad y Metabólica y de la Sociedad Española para el Estudio de la Obesidad · doi:10.53435/funj.00773
“Ante el fallo terapéutico se han descrito diferentes intervenciones quirúrgicas, entre las cuales se encuentran: gastrostomía del remanente gástrico, conversión a manga gástrica, cirugía de reversión y resección pancreática (6).”
BackgroundInfluentialHypoglycemia After Gastric Bypass
Alvarez, G. D. C. (2020) · Gastric Bypass · doi:10.1007/978-3-030-28803-7_35
Chronic Abdominal Pain After Roux-en-Y Gastric Bypass
Ma, P., & Higa, K. D. (2018) · doi:10.1007/978-3-319-75841-1_10
- Authors
- Mala, T.
- Affiliations
- Oslo University Hospital (NO)
- Corresponding author
- Mala, Tom
- ORCID
- Mala, Tom
- Venue
- Surgery for Obesity and Related Diseases
- Publisher
- Elsevier BV
- Published
- 2014-11
- Volume
- 10
- Issue
- 6
- Pages
- 1220-1225
- ISSN
- 1550-7289 (ISSN-L)
- OpenAlex
- W2096258518
- Cited by
- 75
- References
- 0
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 3 · 2023: 7 · 2022: 4 · 2021: 5 · 2020: 2 · 2019: 7 · 2018: 4 · 2017: 7 · 2016: 16 · 2015: 9 · 2014: 2
- FWCI
- 2.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Surgery for Obesity and Related Diseases (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 › Diabetes Management and Research
- Keywords
- postprandial hypoglycemia, Roux-en-Y gastric bypass
- MeSH terms
- Adult, Aged, Female, Follow-Up Studies, Humans, Hyperinsulinism, Hypoglycemia, Male, Middle Aged, Obesity, Morbid, Pancreatectomy, Reoperation, Gastric Bypass, Body Mass Index, Incidence, Risk Assessment, Nesidioblastosis
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