Abstract
Background and Purpose
Dum** syndrome (DS) is a shared but underappreciated complication after metabolic-bariatric surgery. The purpose of the study was to investigate the prevalence and intensity of symptoms suggestive of DS and their relationship with health-related quality of life (HRQOL) after laparoscopic sleeve gastrectomy (LSG).
Method
A retrospective cohort study was performed for all patients with a history of sleeve gastrectomy between July 2017 and July 2022 in our center. Basial clinic statistics were gathered from electronic medical database, the prevalence and severity of DS were assessed by Dum** Symptom Rating Scale (DSRS), and HRQOL is collected through the Short Form Health Survey 36 (SF-36).
Result
In total, 133 of 202 patients completed the questionnaire (response rate 65.8%). A total of 64.7% (N = 86) of participants were female, aged 34.0 (IQR 26.0–39.0) years at completion of the questionnaire, with a mean body mass index of 35.8 (IQR 31.4–40.5) kg/m2. The prevalence of symptoms suggestive of DS was 45.9% (N = 61), and the associated protective factor was the time between surgery and study. Compared with the patients without DS, patients with DS scored significantly worse on four of eight SF-36 subdomains.
Conclusion
Symptoms suggestive of early dum** syndrome after sleeve gastrectomy are common and are associated with a worse health-related quality of life, which deserves clinical attention. Additional counselling, education, and care are needed to mitigate the decline in quality of life caused by dum** symptoms.
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References
Collaboration NCDRF. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377–96. Epub 2016/04/27
Wang L, Zhou B, Zhao Z, et al. Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18. Lancet. 2021;398(10294):53–63. Epub 2021/07/05
Baptista V, Wassef W. Bariatric procedures: an update on techniques, outcomes and complications. Curr Opin Gastroenterol. 2013;29(6):684–93. Epub 2013/10/09
van Beek AP, Emous M, Laville M, et al. Dum** syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management. Obes Rev. 2017;18(1):68–85. Epub 2016/10/18
Scarpellini E, Arts J, Karamanolis G, et al. International consensus on the diagnosis and management of dum** syndrome. Nat Rev Endocrinol. 2020;16(8):448–66. Pubmed Central PMCID: PMC7351708. Epub 2020/05/28
van Furth AM, de Heide LJM, Emous M, et al. Dum** syndrome and postbariatric hypoglycemia: supporting evidence for a common etiology. Surg Obes Relat Dis. 2021;17(11):1912–8. Epub 2021/06/20
Papamargaritis D, Koukoulis G, Sioka E, et al. Dum** symptoms and incidence of hypoglycaemia after provocation test at 6 and 12 months after laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(10):1600–6. Epub 2012/07/10
Tzovaras G, Papamargaritis D, Sioka E, et al. Symptoms suggestive of dum** syndrome after provocation in patients after laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(1):23–8. Epub 2011/06/08
Anandavadivelan P, Wikman A, Malberg K, et al. Prevalence and intensity of dum** symptoms and their association with health-related quality of life following surgery for oesophageal cancer. Clin Nutr. 2021;40(3):1233–40. Epub 2020/09/05
Klevebro F, Boshier PR, Savva KV, et al. Severe dum** symptoms are uncommon following transthoracic esophagectomy however, significantly decrease health-related quality of life in long-term, disease-free survivors. J Gastrointest Surg. 2021;25(8):1941–7. Pubmed Central PMCID: PMC8321973. Epub 2020/11/06
Du X, Luo R, Chen YY, et al. Resected gastric volume has no influence on early weight loss after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2018;14(2):129–35. Epub 2017/12/09
Sun W, Zhang Y, Shen Q, et al. Prevalence and risk factors for symptoms suggestive of hypoglycemia and early dum** syndrome after sleeve gastrectomy. Surg Obes Relat Dis. 2019;15(9):1439–46. Epub 2019/08/21
Nielsen JB, Pedersen AM, Gribsholt SB, et al. Prevalence, severity, and predictors of symptoms of dum** and hypoglycemia after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016;12(8):1562–8. Epub 2016/07/19
Laurenius A, Olbers T, Naslund I, et al. Dum** syndrome following gastric bypass: validation of the dum** symptom rating scale. Obes Surg. 2013;23(6):740–55. Epub 2013/01/15
Ware Jr JE, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1998;51(11):903–12. Epub 1998/11/17
Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin Obes. 2017;7(5):273–89. Pubmed Central PMCID: PMC5600094. Epub 2017/07/12
Li L, Wang HM, Shen Y. Chinese SF-36 Health Survey: translation, cultural adaptation, validation, and normalization. J Epidemiol Community Health. 2003;57(4):259–63. Pubmed Central PMCID: PMC1732425. Epub 2003/03/21
Ahmad A, Kornrich DB, Krasner H, et al. Prevalence of dum** syndrome after laparoscopic sleeve gastrectomy and comparison with laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2019;29(5):1506–13. Epub 2019/01/13
Poljo A, Pentsch A, Raab S, et al. Incidence of dum** syndrome after sleeve gastrectomy, Roux-en-Y gastric bypass and one-anastomosis gastric bypass. J Metab Bariatr Surg. 2021;10(1):23–31. Pubmed Central PMCID: PMC9847648. Epub 2021/06/01
Ramadan M, Loureiro M, Laughlan K, et al. Risk of dum** syndrome after sleeve gastrectomy and Roux-en-Y gastric bypass: early results of a multicentre prospective study. Gastroenterol Res Pract. 2016;2016:2570237. Pubmed Central PMCID: PMC4875983. Epub 2016/06/01
Van Looveren R, Mandeville Y, Logghe P, et al. The effect of dum** on weight loss in conversion of failed restrictive surgery: a cross-sectional pilot study. Obes Surg. 2018;28(3):665–70. Epub 2017/09/22
Kafri N, Valfer R, Nativ O, et al. Health behavior, food tolerance, and satisfaction after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(1):82–8. Epub 2010/12/04
Emous M, Wolffenbuttel BHR, Totte E, et al. The short- to mid-term symptom prevalence of dum** syndrome after primary gastric-bypass surgery and its impact on health-related quality of life. Surg Obes Relat Dis. 2017;13(9):1489–500. Epub 2017/06/19
McLarty AJ, Deschamps C, Trastek VF, et al. Esophageal resection for cancer of the esophagus: long-term function and quality of life. Ann Thorac Surg. 1997;63(6):1568–72. Epub 1997/06/01
Roslin MS, Oren JH, Polan BN, et al. Abnormal glucose tolerance testing after gastric bypass. Surg Obes Relat Dis. 2013;9(1):26–31. Epub 2012/03/09
Figura A, Rose M, Ordemann J, et al. Changes in self-reported eating patterns after laparoscopic sleeve gastrectomy: a prepost analysis and comparison with conservatively treated patients with obesity. Surg Obes Relat Dis. 2017;13(2):129–37. Epub 2016/10/04
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Key Points
Dum** syndrome after sleeve gastrectomy is very common.
Dum** syndrome is associated with a worse healthrelated quality of life.
Counselling, education, and care are needed for dum** syndrome after bariatric surgery.
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Yang, JC., Zhang, GX., Leng, C. et al. Incidence and Intensity of Early Dum** Syndrome and Its Association with Health-Related Quality of Life Following Sleeve Gastrectomy. OBES SURG 33, 3510–3516 (2023). https://doi.org/10.1007/s11695-023-06863-1
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DOI: https://doi.org/10.1007/s11695-023-06863-1