title: Laparoscopic reversal of Roux-en-Y gastric bypass: technique and utility for treatment of endocrine complications.
abstract: BACKGROUND
  The anatomic and physiologic changes with Roux-en-Y gastric bypass (RYGB) may lead to uncommon but occasionally difficult to treat complications such as hyperinsulinemic hypoglycemia with neuroglycopenia and recalcitrant hypocalcemia associated to hypoparathyroidism. Medical management of these complications is challenging. Laparoscopic reversal of RYGB anatomy with restoration of pyloric function and duodenal continuity is a potential treatment. The objective of this study was to present the indications, surgical technique, and clinical outcomes of laparoscopic reversal of RYGB.
  
  
  METHODS
  Prospective study of consecutive patients offered laparoscopic reversal of RYGB.
  
  
  RESULTS
  Five patients with remote laparoscopic RYGB underwent laparoscopic reversal of RYGB to normal anatomy (n = 2) or modified sleeve gastrectomy (n = 3). Indications were medically refractory hyperinsulinemic hypoglycemia with neuroglycopenia (n = 3), recalcitrant hypocalcemia with hypoparathyroidism (n = 1), and both conditions simultaneously (n = 1). Before reversal, all patients had a gastrostomy tube placed in the excluded stomach to document improvement of symptoms. Laparoscopic reversal was accomplished successfully in all patients. Three postoperative complications occurred: bleeding that required transfusion, gallstone pancreatitis, and a superficial trocar site infection. Average length of stay was 3 days. At a mean follow-up of 12 months (range 3 to 22), no additional episodes of neuroglycopenia occurred, average number of hypoglycemic episodes per week decreased from 18.5 ± 12.4 to 1.5 ± 1.9 (P = .05), and hypocalcemia became responsive to oral replacement therapy in both patients.
  
  
  CONCLUSIONS
  Laparoscopic reversal of RYGB to normal anatomy or modified sleeve gastrectomy is feasible and may be a therapeutic option for selected patients with medically refractory hyperinsulinemic hypoglycemia and/or recalcitrant hypocalcemia associated with hypoparathyroidism.
authors.affiliation: Department of Surgery, Division of General Surgery, Section of Foregut and Bariatric Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Electronic address: campos@surgery.wisc.edu.
authors.forename: Guilherme M
authors.initials: GM
authors.lastname: Campos
authors.affiliation: Department of Surgery, Division of General Surgery, Section of Foregut and Bariatric Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Martynas
authors.initials: M
authors.lastname: Ziemelis
authors.affiliation: Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Rodis
authors.initials: R
authors.lastname: Paparodis
authors.affiliation: Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
authors.forename: Dawn Belt
authors.initials: DB
authors.lastname: Davis
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004700:Endocrine System Diseases / Q000209:etiology / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods; D015390:Gastric Bypass / Q000009:adverse effects*; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology*; D006961:Hyperparathyroidism / Q000209:etiology / Q000601:surgery; D006996:Hypocalcemia / Q000209:etiology / Q000601:surgery; D007003:Hypoglycemia / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bariatric surgery; GLP-1; Gastric bypass; Hyperinsulinemic hypoglycemia; Hypocalcemia; Hypoglycemia; Hypoparathyroidism; Laparoscopic reversal; Nesidioblastosis; Reversal; Sleeve gastrectomy