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Obesity Surgery

, Volume 22, Issue 1, pp 23–28 | Cite as

Symptoms Suggestive of Dumping Syndrome After Provocation in Patients After Laparoscopic Sleeve Gastrectomy

  • George Tzovaras
  • Dimitris Papamargaritis
  • Eleni Sioka
  • Eleni Zachari
  • Ioannis Baloyiannis
  • Dimitris Zacharoulis
  • George Koukoulis
Clinical Research

Abstract

Background

Dumping syndrome is a well-known complication after upper gastrointestinal (GI) surgery. There are scarce data in the literature about the incidence of dumping after bariatric operations but, certainly no relation between this syndrome and laparoscopic sleeve gastrectomy (LSG) has been attempted.

Methods

We conducted a prospective clinical study in order to evaluate the potential presence, incidence and severity of Dumping syndrome after LSG. Thirty one non-diabetic morbidly obese patients (eight male, 23 female) eligible for LSG were evaluated. Median age was 38 (22–58 years) and mean body mass index (BMI) was 45.55 (±5.37). The diagnosis of dumping syndrome was based on clinical provocation of signs and symptoms using an oral glucose challenge before and 6 weeks after the operation. The Sigstad’s dumping score was estimated in order to separate dumpers from non-dumpers, and the Arts questionnaire was completed to distinguish between early and late dumping. Moreover, blood glucose levels during the oral glucose challenge were measured.

Results

No patient had symptoms of dumping after provocation preoperatively, whereas after LSG 9 patients (29%) experienced definite dumping and other 5 patients (16%) symptoms suggestive of dumping syndrome. Arts’ questionnaire demonstrated that dumping occurrence after LSG was associated with early symptoms. Late hypoglycaemia occurred in one patient.

Conclusion

A significant proportion of patients after LSG experienced dumping syndrome upon provocation. It seems that LSG should no longer be considered as a pure restrictive procedure, and it might be an option for heavy sweeters by changing their food tolerance patterns.

Keywords

Laparoscopic sleeve gastrectomy Bariatric surgery Dumping syndrome Gastric emptying 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.PubMedCrossRefGoogle Scholar
  2. 2.
    Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy—a “food limiting” operation. Obes Surg. 2008;18:1251–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247:401–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Peterli R, Wölnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250:234–41.PubMedCrossRefGoogle Scholar
  5. 5.
    Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Vecht J, Masclee AAM, Lamers CBHW. The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment. Scand J Gastroenterol Suppl. 1997;223:21–7.PubMedGoogle Scholar
  7. 7.
    Tack J, Arts J, Caenepeel P, et al. Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. 2009;6:583–90.PubMedCrossRefGoogle Scholar
  8. 8.
    Mallory GN, Macgregor AM, Rand CS. The influence of dumping on weight loss after gastric restrictive surgery for morbid obesity. Obes Surg. 1996;6:474–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Abell TL, Minocha A. Gastrointestinal complications of bariatric surgery: diagnosis and therapy. Am J Med Sci. 2006;331:214–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Braghetto I, Davanzo C, Korn O, et al. Scintigraphic evaluation of gastric emptying in obese patients submitted to sleeve gastrectomy compared to normal subjects. Obes Surg. 2009;19:1515–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Bernstine H, Tzioni-Yehoshua R, Groshar D, et al. Gastric emptying is not affected by sleeve gastrectomy—scintigraphic evaluation of gastric emptying after sleeve gastrectomy without removal of the gastric antrum. Obes Surg. 2009;19:293–8.PubMedCrossRefGoogle Scholar
  12. 12.
    NIH Conference. Gastrointestinal surgery for severe obesity Consensus Development Conference Panel.Google Scholar
  13. 13.
    Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2010;in press.Google Scholar
  14. 14.
    Sigstad H. A clinical diagnostic index in the diagnosis of the dumping syndrome. Changes in plasma volume and blood sugar after a test meal. Acta Med Scand. 1970;188:479–86.PubMedCrossRefGoogle Scholar
  15. 15.
    Mehagnoul-Schipper DJ, Lenders JW, Willemsen JJ, et al. Sympathoadrenal activation and the dumping syndrome after gastric surgery. Clin Auton Res. 2000;10:301–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Arts J, Caenepeel P, Bisschops R, et al. Efficacy of the long-acting repeatable formulation of the somatostatin analogue octreotide in postoperative dumping. Clin Gastroenterol Hepatol. 2009;7:432–7.PubMedCrossRefGoogle Scholar
  17. 17.
    1983 metropolitan height and weight tables. [No authors listed] Stat Bull Metrop Life Found. 1983;64:3–9.Google Scholar
  18. 18.
    McLarty AJ, Deschamps C, Trastek W, et al. Esophageal resection for cancer of the esophagus: long-term function and quality of life. Ann Thorac Surg. 1997;63:1568–72.PubMedCrossRefGoogle Scholar
  19. 19.
    Pimpalwar A, Najmaldin A. Results of laparoscopic antireflux procedures in neurologically impaired children. Semin Laparosc Surg. 2002;9:190–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Zaloga GP, Chernow B. Postprandial hypoglycemia after Nissen fundoplication for reflux esophagitis. Gastroenterology. 1983;84:840–2.PubMedGoogle Scholar
  21. 21.
    Sugerman HJ, Starkey JV, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg. 1987;205:613–24.PubMedCrossRefGoogle Scholar
  22. 22.
    Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93:2479–85.PubMedCrossRefGoogle Scholar
  23. 23.
    Baumann T, Kuesters S, Grueneberger J, et al. Time-resolved MRI after ingestion of liquids reveals motility changes after laparoscopic sleeve gastrectomy—preliminary results. Obes Surg. 2011;21:95–101.PubMedCrossRefGoogle Scholar
  24. 24.
    Sanjeevi A. Gastric motility. Curr Opin Gastroenterol. 2007;23:625–30.PubMedCrossRefGoogle Scholar
  25. 25.
    Valderas JP, Irribarra V, Rubio L, et al. Effects of sleeve gastrectomy and medical treatment for obesity on glucagon-like peptide 1 levels and glucose homeostasis in non-diabetic subjects. Obes Surg. 2011 [Epub ahead of print].Google Scholar
  26. 26.
    Valderas JP, Irribarra V, Boza C, et al. Medical and surgical treatments for obesity have opposite effects on peptide YY and appetite: a prospective study controlled for weight loss. J Clin Endocrinol Metab. 2010;95:1069–75.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2011

Authors and Affiliations

  • George Tzovaras
    • 1
    • 3
  • Dimitris Papamargaritis
    • 2
  • Eleni Sioka
    • 1
  • Eleni Zachari
    • 1
  • Ioannis Baloyiannis
    • 1
  • Dimitris Zacharoulis
    • 1
  • George Koukoulis
    • 2
  1. 1.Department of SurgeryUniversity Hospital of LarissaLarissaGreece
  2. 2.Department of EndocrinologyUniversity Hospital of LarissaLarissaGreece
  3. 3.LarissaGreece

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