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Bariatric Surgery In Diabesity

Endocrine And Metabolic Complications development of hypoglycemia.
After Bariatric Surgery Service et al. and Patti et al. described cases of
Bariatric surgery is the most effective therapeutic noninsulinoma pancreatogenous hypoglycemia
option for obese patients; however, it carries syndrome (NIPHS) that presented with symptoms
substantial risks, including procedure-related of postprandial neuroglycopenia secondary to
complications, malabsorption, and hormonal hyperinsulinemic hypoglycemia. Diagnosis of NIPHS
disturbance [6]. was confirmed pathologically by the presence of
diffused islet hypertrophy or nesidioblastosis in
Short-term complicationsThe overall 30-day mortality pancreas.
postoperatively is shown to be less than 1% in general.
Wound infection, bleeding, deep venous thrombosis, The modality of treating hypoglycemia postbariatric
and pulmonary embolism are the early complications surgery depends on the severity of the symptoms
of the surgery, whereas pulmonary embolism and and the response of the patient to the initial dietary
surgical leak are the most common causes of death. recommendations. Patients with early postoperative
mild adrenergic post-postprandial symptoms can
Late complications be managed initially with dietary advises including
frequent, small meals and low-carbohydrate diet.
Late complications related to the surgical
procedure include stomal stenosis, marginal ulcers, For resistant cases, or presenting later postoperative
cholelithiasis, internal and incisional hernias, short and those with severe hypoglycemia require further
bowel syndrome, nutritional deficiencies, and evaluation and therapy. In patients who do not respond
dumping syndrome. well to the dietary modification pharmacological
therapy can be initiated with acarbose, diazoxide,
verapamil, and somatostatin.
Metabolic complications
Metabolic complications of bariatric surgeries include Metabolic bone disease
metabolic acidosis, and/or alkalosis, electrolyte Another complication of increasing concern arising
abnormalities including low calcium, potassium, as a consequence of bariatric surgery is metabolic
magnesium, sodium, and phosphorus that may bone disease that leads up to osteoporosis and
cause arrhythmias and/or myopathies. Nutritional osteoporotic fracture.
abnormalities in the form of fat-soluble vitamin
deficiencies involving A, D, E, and K, iron and folic acid The impact of major weight loss on bone metabolism
deficiency, negative calcium balance, and vitamin D after bariatric surgery was until recently considered
deficiency causing secondary hyperparathyroidism, to be the sole result of a combination of mechanical
oxalosis, kidney stones, thiamine deficiency, vitamin and nutritional effects. The notion changed with
B12 deficiency, increased bacterial overgrowth causing recent insights, which showed an intricate and
nocturnal diarrhea and abdominal distension, have complex interplay between the signaling factors
been documented. of gut, bone, and fat tissue, utilizing a third
neurohormonal mechanism regulating bone turnover
Hypoglycemia through adipokines; leptin and adiponectin, gonadal
Hypoglycemia is increasingly being recognized as steroids,] and gut-derived hormones. GIP’s receptor,
a complication of gastric bypass surgeries. Relative glucose-dependent insulinotropic polypeptide
risk of hypoglycemia increases sevenfold in the receptor (GIPR), is expressed in bone tissue and its
postgastric bypass population, and the frequency of deficiency in animals reportedly led to increased
asymptomatic documented hypoglycemia after oral bone resorption with a pronounced reduction in the
glucose tolerance test reached 30% among postgastric degree of mineralization of bone matrix.
bypass patients. A median time from surgery to The degree of bone loss or disease varies with the
development of symptoms was observed to be 2.7 type of surgery undertaken. Surgeries employing
years. The pathophysiology of hypoglycemia remains malabsorptive techniques such as RYGB, bypass the
controversial; dumping syndrome, an increase in beta primary absorption sites for vitamins and minerals,
cell mass, alteration of beta cell function, and other that is, the duodenum and proximal jejunum resulting
factors not related to beta cell were all suggested in deficiencies of key osteogenic factors such as
as possible mechanisms. In addition, increased calcium that is actively absorbed from the proximal
weight loss following surgery along with an increase foregut, and vitamin D that requires bile acids and
in insulin sensitivity may additionally contribute to pancreatic secretions for optimal absorption.

GCDC 2017