Hyper-insulinemic hypo-glycemia is an important late complication of gastric bypass surgery that is increasingly recognized in patients who have undergone Roux-en-Y gastric bypass. It is a condition characterized by shortage of glucose in the brain (neuroglycopenia) and abnormal elevated insulin concentrations experienced mainly after eating a meal.
Hyperinsulinemic hypoglycemia is caused by unregulated secretion of insulin by the pancreatic beta-cels. The obesrved postprandial hyperglycemia is caused from the rapid digestion and absorption of ingested carbohydrates. This is a common phenomenon in gastric bypass patients and is related to the dumping syndrome—the result of food passing too quickly from the stomach to the small intestine.
Post-gastric bypass hyperinsulinemic hypoglycemia causes confusion, lightheadedness and loss of consciousness after a carbohydrate-rich meal.
Although the treatment of the disorder remains elusive, a number of studies have investigated the following three approaches
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Sleeve Gastrectomy (SG) is a procedure that permanently reduces the size of the stomach to about 60-80 cc (half a cup). The gastric restriction makes patients lose weight because they eat less. However, it is not only the smaller size of the stomach that creates the early feeling of fullness. It is also the fact that by surgically removing 70% of the stomach along the greater curvature, the procedure takes off a part of the stomach, called fundus, that produces ghrelin, a hormone that is involved in the perception of hunger.
Surgical treatment of clinically severe obesity has been proven to be an effective solution for long-term weight reduction. But as weight loss surgery rates are soaring, revisional bariatric operations are increasing as well. This is because simple gastric restrictive methods, such as adjustable gastric banding, vertical banded gastroplasty, and nonadjustable gastric banding often give rise to intolerable side effects or simply fail to control weight in the long run.
Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric operation. Without bypassing the intestines or causing any gastrointestinal malabsorption, the LSG procedure generates weight loss by removing 85% of the stomach. The stomach is resected vertically and reduced to a narrow tube.
Sleeve gastrectomy is a bariatric procedure that has become vastly popular due to its great efficacy for weight loss. It is performed either as a sole operation in morbidly obese people or as a first step in super-obese patients, followed by a second intervention, which is usually Roux-en-Y gastric bypass (RYGB) or bilio-pancreatic diversion with duodenal switch (BPDDS).
Sleeve gastrectomy (also called vertical sleeve gastrectomy) involves removing about 85% of the stomach thus restricting the amount of food that can be eaten. Unlike gastric bypass, sleeve gastrectomy procedure leaves the intestines intact. It is therefore a purely restrictive procedure. No gastrointestinal malabsorption occurs since the intestines are not bypassed. Although it is less invasive than gastric bypass, recent studies show that it has similar short and intermediate-term results with gastric bypass.
Super obese patients undergoing bariatric surgery present multiple risks for medical, surgical and anesthetic complications. The best surgical procedure for the super obese patient to achieve optimum weigh loss is always a matter of concern. The high rate of risk dictates that this group of patients needs less aggressive, shorter duration, and less invasive surgical treatment options.
As obesity is rapidly increasing in the United States, so does the number of weight loss surgeries performed each year. The most popular surgical procedure for weigth loss today in the United States is gastric bypass. Second common is gastric banding. Duodenal switch and gastric sleeve are less routinely performed. A recent study, conducted in Weill Cornell College of Medicine (New York), compared the effect of the four mostly performed weight loss surgery procedures on weight loss and body fat.
A number of types of surgical treatment are available to facilitate weight loss in obese people and reduce their incidence of associated health problems, especially diabetes. For those who are willing to undergo surgery, gastric bypass (Roux-en-Y) has long been the most common option. Bypass surgery does tend to yield the best results in terms of overall weight loss, but it still has some drawbacks. Like any major surgery, the procedure entails some risks.
Recently, however, researchers at the Massachusetts General Hospital (MGH) Weight Center and Gastrointestinal Unit have developed and tested a new way of treating obesity through “incisionless bariatric surgery.” A new medical device—called an endoluminal (i.e., intra-intestinal) sleeve (ELS)—which can be inserted endoscopically, mimics the effects of gastric bypass by sealing off the upper portion of the small intestine with an impermeable lining that prevents the intestine from sensing and absorbing the nutrients in food so that it passes through to the lower intestinal tract relatively undigested.
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