Skip to main content

Advertisement

SpringerLink
Log in

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

  • Clinical Research
  • Published:
Obesity Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.

    Article  PubMed  Google Scholar 

  2. Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy—a “food limiting” operation. Obes Surg. 2008;18:1251–6.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  5. Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.

    Article  PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  9. Abell TL, Minocha A. Gastrointestinal complications of bariatric surgery: diagnosis and therapy. Am J Med Sci. 2006;331:214–8.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  12. NIH Conference. Gastrointestinal surgery for severe obesity Consensus Development Conference Panel.

  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.

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  17. 1983 metropolitan height and weight tables. [No authors listed] Stat Bull Metrop Life Found. 1983;64:3–9.

  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.

    Article  PubMed  CAS  Google Scholar 

  19. Pimpalwar A, Najmaldin A. Results of laparoscopic antireflux procedures in neurologically impaired children. Semin Laparosc Surg. 2002;9:190–6.

    Article  PubMed  CAS  Google Scholar 

  20. Zaloga GP, Chernow B. Postprandial hypoglycemia after Nissen fundoplication for reflux esophagitis. Gastroenterology. 1983;84:840–2.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  24. Sanjeevi A. Gastric motility. Curr Opin Gastroenterol. 2007;23:625–30.

    Article  PubMed  Google Scholar 

  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].

  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.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Author notes

  1. George Tzovaras

    Present address: , 19 Agorogianni A. Street, Larissa, 413 35, Greece

Authors and Affiliations

  1. Department of Surgery, University Hospital of Larissa, Viopolis, Larissa, 411 10, Greece

    George Tzovaras, Eleni Sioka, Eleni Zachari, Ioannis Baloyiannis & Dimitris Zacharoulis

  2. Department of Endocrinology, University Hospital of Larissa, Viopolis, Larissa, 411 10, Greece

    Dimitris Papamargaritis & George Koukoulis

Authors
  1. George Tzovaras
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dimitris Papamargaritis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eleni Sioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eleni Zachari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ioannis Baloyiannis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dimitris Zacharoulis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. George Koukoulis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George Tzovaras.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tzovaras, G., Papamargaritis, D., Sioka, E. et al. Symptoms Suggestive of Dumping Syndrome After Provocation in Patients After Laparoscopic Sleeve Gastrectomy. OBES SURG 22, 23–28 (2012). https://doi.org/10.1007/s11695-011-0461-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-011-0461-7

Keywords

Search

Navigation