Revision of Roux-en-Y Gastric Bypass to Sleeve Gastrectomy for Reactive Hypoglycemia

Saber Ghiassi, MD MPH, Benjamin Shadle, MD, Keith Boone, MD FACS, Kelvin Higa, MD FACS. University of California, San Francisco, Fresno


Severe reactive hypoglycemia following gastric bypass is a rare late complication that typically presents 1-5 years after surgery. Hypoglycemia results from an exaggerated insulin response to a glucose load. Etiology may include the rapid transit of food to the small intestine due to lack of the pyloric channel and hypertrophic pancreatic islet cells due to elevated GLP-1. However, the exact cause of the hyperinsulinemia is unknown.

We present the case of a 50 year-old woman who presented with severe reactive hypoglycemia 7 years after laparoscopic Roux-en-Y gastric bypass. Her symptoms improved but continued despite dietary modification and medical therapy with Acarbose. Patient’s symptoms resolved with tube feeds after laparoscopic gastrostomy tube insertion. She then underwent laparoscopic revision of Roux-en-Y gastric bypass to sleeve gastrectomy. She has been asymptomatic with normal blood glucose at follow-up.

Session Number: SS08 – Videos: Obesity Surgery
Program Number: V010

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