Hypoglycemia is an uncommon long term complication from RYGB, but with significant quality of life implication. After completing a full study demonstrating hyperinsulinemic hypoglycaemia, and failure of medical treatments, the malabsorptive component of the RYGB should be performed. Then conversion to sleeve gastrectomy in order to maintain some restrictive component is a choice.
We present a video of a lady with hypoglycemias after RYGB. Patient failed to response to medical treatment to Acarbose and Lyraglutide. Another pathological diagnosis for hypoglycemies were discarded. Patient was proposed to be converted to SG.
We performed a 5 port laparoscopic approach. After counting the small bowel limbs, the Roux limb was preserved, so it was resected from the pouch and anastomosed to the biliopancreatic limb. Then the proximal ending of the pouch was resected and the excluded stomach was prepared for the new gastro-gastric anastomosis. As the patient is planned to be converted for SG, fundectomy of the excluded stomach was performed. Patient did well, oral tolerance was right and hypoglycemia were resolved.
Conversion to SG is a valid choice for patients with hypoglycemia. It is a challenging procedure but effective in order to deal with this complication.