When gastric bypass fails: revisiting anatomy with the Branco-Zorron switch for severe PHH: a case report
Abstract
Introduction and importance: Postprandial hyperinsulinemic hypoglycemia (PHH) is a significant, rare complication following Roux-en-Y gastric bypass (RYGB). Management is challenging in patients with complex revisional surgical histories, where conservative treatments often fail. This case highlights the need for individualized surgical solutions for severe, refractory PHH in this unique patient population.
Case presentation: We present a 71-year-old woman with a history of a sleeve gastrectomy revised to an RYGB, who developed debilitating hypoglycemic episodes refractory to conservative management. An oral glucose tolerance test (OGTT) yielded results consistent with PHH, revealing a paradoxical glucose drop with an exaggerated insulin and C-peptide response.
Clinical discussion: Given her complex anatomy and atypical, low-volume gastric remnant consisting primarily of the antrum, a laparoscopic Branco-Zorron switch was performed to restore pyloric function and delay gastric emptying. Postoperatively, the patient experienced sustained resolution of her hypoglycemic symptoms, accompanied by positive weight gain and high satisfaction. Her recovery was complicated by an intra-abdominal abscess, which was successfully managed conservatively.
Conclusion: The Branco-Zorron switch is a promising surgical option for severe, refractory PHH, particularly in patients with complex post-bariatric anatomies. This case underscores the efficacy of tailored reconstructive approaches when…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- The Matrisome: In Silico Definition and In Vivo Characterization by Proteomics of Normal and Tumor Extracellular Matrices
- The Escherichia coli MG1655 in silico metabolic genotype: Its definition, characteristics, and capabilities
- In silico pharmacology for drug discovery: methods for virtual ligand screening and profiling
- In silico prediction of splice-altering single nucleotide variants in the human genome
- In silico clinical trials: how computer simulation will transform the biomedical industry
- In silico optimization of a guava antimicrobial peptide enables combinatorial exploration for peptide design
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.