Dumping syndrome after bariatric surgery is common. However, it is rarely seen during pregnancy because patients are usually advised to avoid pregnancy immediately after surgery. This case highlights the importance of avoidance of pregnancy after bariatric surgery. We report a case of unplanned pregnancy in a 35-year-old woman with a history of subfertility for 8 years who conceived spontaneously 3 months after gastric bypass surgery. This occurred because there was no contraception offered to her after the procedure. The pregnancy was complicated with recurrent episodes of hypoglycaemia secondary to dumping syndrome. Primary care providers need to be vigilant and have a high index of suspicion for dumping syndrome in pregnant obese women who have undergone bariatric surgery.
Dumping Syndrome ; Hypoglycemia

Dumping syndrome is a common complication of esophageal or gastric surgery. Patients with late dumping syndrome usually suffer from hypoglycemic symptoms such as palpitation, tremor, and general weakness. Hypoglycemia induced convulsive seizure due to late dumping syndrome is rarely reported. We report a 46-year-old man with postprandial hypoglycemic convulsive seizure as the first symptom of late dumping syndrome.
Dumping Syndrome ; Humans ; Hypoglycemia ; Middle Aged ; Seizures ; Tremor

OBJECTIVETo evaluate the feasibility and safety of the delta-shaped anastomosis in laparoscopic distal gastrectomy and digestive tract reconstruction.

METHODSClinical data of 34 gastric cancer patients undergoing laparoscopic distal gastrectomy with the delta-shaped anastomosis for digestive tract reconstruction (delta-shaped group) and 83 gastric cancer patients undergoing laparoscopic distal gastrectomy with Billroth I( for digestive tract reconstruction (Billroth group) by same surgeon team from July 2013 to July 2015 at the Department of Digestive Surgery, Affiliated Tumor Hospital of Shanxi Medical University were retrospectively analyzed. Data of two groups were compared.

RESULTAge, gender, tumor stage were not significantly different between the two groups(all P>0.05). Operation time of the first 15 cases in delta-shaped group was longer than that in Billroth group [(254.7±35.4) min vs. (177.8±33.0) min, t=11.190, P=0.000], while after above 15 cases, the operation time of delta-shaped group was significantly shorter than that of Billroth group [(142.1±14.6) min vs. (177.8±33.0) min, t=-4.109, P=0.001]. Delta-shaped group had less blood loss during operation [(87.1±36.7) ml vs. (194.0±55.1) ml, t=-10.268, P=0.000], and shorter length of incision [(4.1±0.4) cm vs. (6.1±1.0) cm, t=-10.331, P=0.000] than Billroth group. Compared with Billroth group, delta-shaped group presented faster postoperative bowel function return [(2.8±0.6) d vs. (3.3±0.5) d, t=-3.755, P=0.000], earlier liquid food intake [(7.4±1.5) d vs. (8.1±1.7) d, t=-4.135, P=0.000], earlier ambulation [(4.0±1.6) d vs. (6.8±1.4) d, t=-7.197, P=0.000] and shorter postoperative hospital stay [(12.6±1.9) d vs.(13.6±2.0) d, t=-20.149, P=0.000]. Morbidity of postoperative complication was 5.9%(2/34) in delta-shaped group, including anastomotic fistula in 1 case and incision infection in 1 case, and 6.0%(5/83) in Billroth group, including anastomotic fistula, incision infection, anastomotic stricture and dumping syndrome, without significant difference(P>0.05). Difference value of total protein and albumin between pre-operation and post-operation, and average decreased value of total protein, albumin, body weight between pre-operation and postoperative 6-month were not significantly different between two groups(all P>0.05). As for patients with BMI > 25 kg/m, compared to Billroth group, delta-shaped group presented less blood loss during operation [(94.1±36.7) ml vs. (203.0±55.1) ml, t=-10.268, P=0.000], lower injective dosage of postoperative analgesics [(1.9±1.1) ampule vs.(3.3±2.0) ampule, t=-2.188, P=0.032], faster intestinal recovery [(2.9±0.7) d vs. (3.2±0.9) d, t=-3.755, P=0.009], shorter hospital stay [(10.5±1.2) d vs. (11.7±1.5) d, t=-2.026, P=0.004], and lower morbidity of postoperative complication [7.1%(1/14) vs. 13.6%(3/22), χ=4.066, P=0.031].

CONCLUSIONIn laparoscopic distal gastrectomy and digestive tract reconstruction, the delta-shaped anastomosis is safe and feasible, especially suitable for obese patients.

Anastomosis, Surgical ; adverse effects ; methods ; Blood Loss, Surgical ; statistics & numerical data ; Comparative Effectiveness Research ; Constriction, Pathologic ; epidemiology ; etiology ; Defecation ; Digestive System Fistula ; epidemiology ; etiology ; Drinking ; Dumping Syndrome ; epidemiology ; etiology ; Female ; Gastrectomy ; adverse effects ; methods ; Gastroenterostomy ; adverse effects ; methods ; Humans ; Laparoscopy ; adverse effects ; methods ; Length of Stay ; Male ; Operative Time ; Postoperative Complications ; epidemiology ; Postoperative Period ; Recovery of Function ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Surgical Wound ; Surgical Wound Infection ; epidemiology ; Treatment Outcome

This case report discusses dumping syndrome in the postbariatric mother. Diagnostically a challenge, the symptoms of postprandial hypoglycaemia mimic common early gestation complaints and may go undiagnosed, thus requiring a high index of suspicion. As weight-loss surgery gains traction, it is pertinent to note at booking and followups. The pregnancy is at-risk and multidisciplinary team management is central. The mainstay of management remains diet modification. There have been case reports of successful medical treatment of dumping syndrome in pregnancy with good maternal and fetal outcomes. However, more data is needed regarding the usage of these medical treatments in pregnancy.
Dumping Syndrome ; pregnancy

Pylorus-preserving gastrectomy (PPG) is a function-preserving surgery for the treatment of early gastric cancer (EGC), aiming to decrease the complication rate and improve postoperative quality of life. According to the Japanese gastric cancer treatment guidelines, PPG can be performed for cT1N0M0 gastric cancer located in the middle-third of the stomach, at least 4.0 cm away from the pylorus. Although the length of the antral cuff gradually increased, from 1.5 cm during the initial use of the procedure to 3.0 cm currently, its optimal length still remains unclear. Standard procedures for the preservation of pyloric function, infra-pyloric vessels, and hepatic branch of the vagus nerve, make PPG technically more difficult and raise concerns about incomplete lymph node dissection. The short- and long-term oncological and survival outcomes of PPG were comparable to those for distal gastrectomy, but with several advantages such as a lower incidence of dumping syndrome, bile reflux, and gallstone formation, and improved nutritional status. Gastric stasis, a typical complication of PPG, can be effectively treated by balloon dilatation and stent insertion. Robot-assisted pylorus-preserving gastrectomy is feasible for EGC in the middle-third of the stomach in terms of the short-term clinical outcome. However, any benefits over laparoscopy-assisted PPG (LAPPG) from the patient's perspective have not yet been proven. An ongoing Korean multicenter randomized controlled trial (KLASS-04), which compares LAPPG and laparoscopy-assisted distal gastrectomy for EGC in the middle-third of the stomach, may provide more clear evidence about the advantages and oncologic safety of PPG.
Asian Continental Ancestry Group ; Bile Reflux ; Dilatation ; Dumping Syndrome ; Gallstones ; Gastrectomy* ; Gastroparesis ; Humans ; Incidence ; Lymph Node Excision ; Nutritional Status ; Pylorus ; Quality of Life ; Stents ; Stomach ; Stomach Neoplasms* ; Vagus Nerve

Patients with diabetes undergo bariatric surgery to improve sugar metabolism and to achieve weight loss. However, possible complications after bariatric surgery must be carefully considered. We report a case of uncontrolled blood sugar after bariatric surgery despite weight loss in a severely obese patient with diabetes. The patient underwent bariatric surgery in 2009 in order to lose weight and improve glycemic control. Six months after the surgery, the patient experienced dumping syndrome. The patient did actually lose weight; however, as the visceral fat/subcutaneous fat+visceral fat ratio increased, insulin resistance was not improved, and glycemic control was aggravated. The patient received proper medication for dumping syndrome including nutritional support and exercise education. Due to these efforts, the patient has maintained her weight loss, and her blood sugar level was controlled within the target range.
Bariatric Surgery ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Dumping Syndrome ; Education ; Humans ; Insulin Resistance ; Insulin ; Intra-Abdominal Fat ; Metabolism ; Nutritional Support ; Protein-Energy Malnutrition ; Weight Loss

PURPOSE: The aim of this study was to investigate the change of nutritional status and the incidence of dumping syndrome after gastrectomy for gastric cancer. METHODS: From January 2013 to May 2014, 36 patients who underwent gastrectomy for gastric cancer were prospectively investigated in terms of nutritional status by body weight, anthropometric measurements, biochemical data, and Patient-Generated Subjective Global Assessment (PG-SGA). Dumping syndrome was assessed using a newly developed questionnaire based on the Japanese Society of Gastroenterological Surgery survey and Sigstad's scoring system. RESULTS: Body weight losses were 4.6%, 8.1%, and 6.9% at discharge, six months, and one year after discharge, respectively. Triceps skinfold thickness had no significance, however, mid-arm muscle circumference showed significant loss after gastrectomy. A part of the biochemical data showed significant change after gastrectomy, but almost indicated a restoring tendency within two months after discharge. In terms of PG-SGA, 33 patients (91.7%) were classified as A (well-nourished) before surgery, however, the number of well-nourished patients showed a sharp decrease to 1 (2.8%) at two weeks after discharge, and then gradually increased to 25 (69.4%) at one year. The main obstacles against diet intake were reported as 'early satiety' and 'anxiety'. The number of patients who had experience in at least one dumping syndrome related symptom was 21 (58.3%) at discharge, 26 (72.2%) at two months after discharge, and 11 (30.6%) at one year after discharge. CONCLUSION: Nutritional deficit as well as dumping syndrome is encountered in a large number of gastric cancer patients after gastrectomy. Postoperative nutritional support and personalized education seem to be very important during the postoperative period.
Asian Continental Ancestry Group ; Body Weight ; Diet ; Dumping Syndrome* ; Education ; Gastrectomy* ; Humans ; Incidence* ; Nutritional Status* ; Nutritional Support ; Observational Study* ; Postoperative Period ; Prospective Studies* ; Skinfold Thickness ; Stomach Neoplasms ; Surveys and Questionnaires

No abstract available.
Adult ; Dumping Syndrome ; Gastrostomy ; Humans ; Persistent Vegetative State

The purpose of this survey is to investigate the nutritional status and dietary intake of gastrectomized cancer patients in Asan Medical Center. The subjects were 98 patients, who underwent a gastrectomy due to gastric cancer and were admitted to the General Surgery Department during March 2007 to December 2007. We examined general characteristics (sex, age, clinicopathological stage, type of operation), anthropometric data (height, weight change), biochemical data (red blood cell RBC, hemoglobin HGB, hematocrit HCT, mean corpuscular volume MCV, total lymphocyte count TLC, albumin, total cholesterol), dietary intake and dietary intake related symptoms. Weight loss of gastrectomized patients was 9.0 +/- 4.3% from preillness weight to visiting out-patient department (OPD) weight. Biochemical data (RBC, HGB, HCT, MCV, TLC, albumin, total cholesterol) significantly deteriorated after gastrectomy. However, outpatient visits were all restored to the normal range. Postoperative energy intake was 785.0 +/- 164.2 kcal, which corresponds to 41.6 +/- 9.6% of daily energy requirement. The cause of poor oral intake is mostly fear, abdominal pain and abdominal discomfort. Therefore, to control pre-or post-operative weight change in the future requires, focusing on the body weight to maintain a normal or usual nutrition by interventions and increased caloric intake during hospitalization for the development of nutrient-dense meals. In addition, as the main reason of the lack of intake of meals after the gastrectomy was fear, the patients should be actively encouraged to consider the importance of eating proper meals.
Abdominal Pain ; Blood Cells ; Body Weight ; Dumping Syndrome ; Eating ; Energy Intake ; Erythrocyte Indices ; Gastrectomy ; Hematocrit ; Hemoglobins ; Hospitalization ; Humans ; Lymphocyte Count ; Meals ; Nutritional Status ; Outpatients ; Reference Values ; Stomach Neoplasms ; Weight Loss

The need for gastric surgery for peptic ulcer disease has decreased since the discovery of Helicobacter pylori and the development of proton pump inhibitors. Nevertheless, the total frequency of gastric surgery has increased due to the frequent detection of early gastric cancer and the increasing morbidity of pathological obesity. After gastric surgery, several unwanted gastrointestinal (GI) problems can develop as a result of the altered anatomy, volume reduction, or vagal impairment. Acute organic GI problems after gastric surgery include intraoperative or postoperative intestinal bleeding, leakage, and obstruction. Chronic organic problems include anastomosis site strictures, various metabolic disturbances, retained antrum syndrome, afferent or efferent loop syndrome, and gallstones. Chronic functional problems after gastric surgery include dumping syndrome, acid or bile regurgitation, postvagotomy diarrhea, and gastroparesis. Recently, concern about patients' postoperative quality of life and life expectancy after gastric surgery has increased. To avoid undesirable outcomes after gastric surgery, the early detection and appropriate management of surgery-related disturbances are important. Therefore, it will be helpful to review these problems here.
Bile ; Constriction, Pathologic ; Diarrhea ; Dumping Syndrome ; Gallstones ; Gastrectomy ; Gastrointestinal Diseases ; Gastroparesis ; Helicobacter pylori ; Hemorrhage ; Life Expectancy ; Obesity ; Peptic Ulcer ; Proton Pump Inhibitors ; Quality of Life ; Stomach Neoplasms