IBC Oxford University Poster Abstract 3 - Novel technique in reversal of RYGB leads to remission of postprandial hyperinsulinaemic

Abstract Background and Aim Postprandial hyperinsulinaemic hypoglycaemia is one of the complications occurring after Roux-en-Y gastric bypass. Nutritional and medical treatment are considered first line of treatment, but some cases are deemed intractable as to why surgical options are explored. Amongst these, a novel technique—Functional reversal—has been proposed as an alternative to anatomic reversal that elsewise carries a higher complication rate and is technically more demanding. In this case report the effect of functional reversal in alleviating intractable hypoglycaemia was assessed. Case Presentation We present the case of a 62-year-old Caucasian male who had undergone Roux-en-Y Gastric bypass for morbid obesity. Shortly after the procedure he started complaining of episodical hypoglycaemia that aggravated to daily symptoms consistent with Whipple’s Triad. Conservative treatment with Acarbose and Liraglutide along with dietary regulations proved futile and he underwent a functional reversal that entailed a laparoscopic construction of a gastro-gastric fistula thus enabling a passageway through the otherwise remnant stomach of his gastric bypass. Immediately after the procedure, serum-glucose levels normalized. Continuous glucose monitoring four months after surgery showed resolution of his postprandial hyperinsulinaemic hypoglycaemia. Eating and dietary habits returned to normal. Conclusion Functional reversal leads to resolution of intractable postprandial hyperinsulinaemic hypoglycaemia after RYGB. Prospective studies should evaluate the reproducibility of the treatment effect and could thus prove a safe and viable alternative to anatomic reversal.