PubMed · 13721644
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E H DELLINGER. 1961. Avoiding the dumping syndrome.. https://pubmed.ncbi.nlm.nih.gov/13721644/
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HISTORY: A 64-year old somnolent man was admitted to the emergency department with a reported seizure half an hour earlier. Due to similar episodes the patient had been treated with antiepileptics in the past. The patient s past history revealed a partial gastrectomy (Billroth II) more than ten years ago. DIAGNOSTIC FINDINGS AND THERAPY: At the time of admission blood glucose was 31 mg/dl. Other routine laboratory analyses and the clinical examination were normal. In addition, a detailed neurological examination and a cranial CT-scan were normal. Due to the hypoglycemia a dumping syndrome was suspected. A three hour oral glucose tolerance test (OGTT) resulted in a late hypoglycemia, establishing the diagnosis of late dumping. After adaptation of the patient's diet no further hypoglycemic episodes occurred. CONCLUSION: Manifestation of a dumping syndrome may occur even years after gastrectomy. Therefore, in patients presenting with hypoglycemia and a history of gut surgery, a dumping syndrome should be suspected. Furthermore, seizures due to hypoglycemia may be the only manifestation of late dumping.
Aiming to minimize the surgical trauma and interventional risks of treatment, as well as to reach the most precise visualization and safe separation of the n. vagus, in order to increase the efficacy of truncal vagotomy during correction of severe post-gastric-resection dumping syndrome we have developed the new method of thoracoscopic supradiafragmal vagotomy. The suggested method of bilateral thoracoscopic supradiafragmal truncal vagotomy allows to decrease the surgical intervention trauma, and the risk of post operative complications, as well as to better the immediate and remote results of treatment of the dumping syndrome.
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