Article
One-Anastomosis Jejunal Interposition with Gastric Remnant Resection (Branco-Zorron Procedure): Successful Management of Severe Chronic Hypoglicemia Post Gastric Bypass – Pilot Clinical Series
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Authors
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Ricardo Zorron
- Charité-Universtätsmedizin Berlin, Center of Innovative Surgery (ZIC), Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland
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Alcides Branco
- Klinikum Bremerhaven Reinkenheide, Department for General, Visceral, Thorax and Vascular Surgery, Bremerhaven, Deutschland
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Jose Sampaio
- Klinikum Bremerhaven Reinkenheide, Department for General, Visceral, Thorax and Vascular Surgery, Bremerhaven, Deutschland
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Tido Junghans
- Klinikum Bremerhaven Reinkenheide, Department for General, Visceral, Thorax and Vascular Surgery, Bremerhaven, Deutschland
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Claudia Bothe
- Klinikum Bremerhaven Reinkenheide, Department for General, Visceral, Thorax and Vascular Surgery, Bremerhaven, Deutschland
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Johann Pratschke
- Charité-Universtätsmedizin Berlin, Center of Innovative Surgery (ZIC), Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland
| Published: | April 21, 2016 |
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Outline
Text
Introduction: Postprandial chronic hypoglycaemia following gastric bypass for obesity is considered a late manifestation of the dumping syndrome. The anatomic and physiologic changes of the operation may lead to uncommon but difficult to treat complication as hyperinsulinemic hypoglycemia with neuroglycopenia. For patients non-responders for conservative treatment, extreme therapy with distal pancreatectomy or revision to normal anatomy were reported. We propose a new procedure to effectively treat this complication after bariatric surgery and applied in a pilot clinical series.
Methods: Laparoscopic revision with One-Anastomosis jejunal interposition and gastric remnant and alimentary limb jejunal resection (Branco-Zorron Procedure) was performed in 4 symptomatic and irresponsive to medical treatment patients with chronic symptomatic hypoglycemia from 2 to 11 years after RYGB. Technical steps included:
- 1.
- Fully adhesiolysis and recognition of anatomy;
- 2.
- Remnant gastrectomy with stapling ca 3 cm from pylorus.
- 3.
- Section of the jejunal limb 20cm from GE.
- 4.
- Handsewn anastomosis between jejunal interposition and remnant antrum.
- 5.
- Resection of the remnant alimentary limb.
- 6.
- Leak testing with methylene blue.
Results: All patients were submitted to the procedure without intraoperative complications. BMI evolved from a mean of 42.0 to 26.5kg/m2 after a mean of 20 months follow-up. Mean operative time for revisions was 188 min. Postoperative stay was 6 days. Follow-up showed normalization of insulin levels from a mean of 8.2 to 3.2microUI/ml and Hba1c normalization.
Conclusions: Revisions after bariatric surgery shall preserve anatomical and physiologic normalization. The surgical therapy for symptomatic hypoglycemia was successful in all cases using the technique, possibly because of restoring the function of the duodenum allowing reduction of GIP and GLP-1 and hyperinsulinemia, and reducing ghrelin production due to fundic resection. Jejunal interposition isa sfae therapy for hyperinsulinemic hypoglycemia post gastric bypass in selected patients.
Figure 1 [Fig. 1]
