Refractory hypoglycemia after Roux-en-Y gastric bypass: surgical management by reversal

Abstract

Objective: To analyze the role of surgical reversal of Roux-en-Y gastric bypass (RYGB) in the management of refractory hypoglycemia. Case report: A 61-year-old female with a history of RYGB performed 10 years earlier, with a body mass index of 19.9 kg/m², presented with recurrent symptomatic hypoglycemia fulfilling Whipple’s triad, refractory to dietary and pharmacological management. After multidisciplinary evaluation and absence of anatomical abnormalities, laparoscopic reversal with Roux limb resection and gastro-gastric anastomosis was performed. The postoperative course was uneventful, with complete resolution of hypoglycemic episodes at 6-month follow-up. Discussion: Post-bariatric hypoglycemia is an uncommon but potentially disabling complication. In refractory cases, surgical reversal may be considered in selected patients, particularly when conservative management fails.