Laparoscopic Revision of Bariatric Surgeries in Two Patients with Severe Resistant Hypocalcemia After Endocrine Cervical Surgery

Zaarour, Magda; Zaharia, Ramona; Bretault, Marion; Jublanc, Christel; Marcellus, C. De; Bouillot, Jean‐Luc; Lefebvre, Henri; Oppert, Jean‐Michel; Aron‐Wisnewsky, Judith; Raffin-Sanson, Marie-Laure

doi:10.1007/s11695-019-04132-8

Cited by 8 publications

(3 citation statements)

References 10 publications

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“…11 Postsurgical hypoparathyroidism with prior gastric bypass often results in recalcitrant hypocalcemia, at times requiring prolonged parenteral calcium, and even reversal of the gastric bypass with varying results. 12,13 Leveraging surgical technologies to prevent PG injury is therefore important.…”

Section: Discussionmentioning

confidence: 99%

“…Undertreatment of pregnant or breastfeeding patients can lead to maternal hypocalcemia (linked to premature delivery, intrauterine fetal hyperparathyroidism, and fetal death), while overtreatment can result in abortion, stillbirth, perinatal death, and neonatal tetany . Postsurgical hypoparathyroidism with prior gastric bypass often results in recalcitrant hypocalcemia, at times requiring prolonged parenteral calcium, and even reversal of the gastric bypass with varying results . Leveraging surgical technologies to prevent PG injury is therefore important.…”

Section: Discussionmentioning

confidence: 99%

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Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery

Karcioglu

Triponez

Solórzano

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceIdentification and preservation of parathyroid glands (PGs) remain challenging despite advances in surgical techniques. Considerable morbidity and even mortality result from hypoparathyroidism caused by devascularization or inadvertent removal of PGs. Emerging imaging technologies hold promise to improve identification and preservation of PGs during thyroid surgery.ObservationThis narrative review (1) comprehensively reviews PG identification and vascular assessment using near-infrared autofluorescence (NIRAF)—both label free and in combination with indocyanine green—based on a comprehensive literature review and (2) offers a manual for possible implementation these emerging technologies in thyroid surgery.Conclusions and RelevanceEmerging technologies hold promise to improve PG identification and preservation during thyroidectomy. Future research should address variables affecting the degree of fluorescence in NIRAF, standardization of signal quantification, definitions and standardization of parameters of indocyanine green injection that correlate with postoperative PG function, the financial effect of these emerging technologies on near-term and longer-term costs, the adoption learning curve and effect on surgical training, and long-term outcomes of key quality metrics in adequately powered randomized clinical trials evaluating PG preservation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery

Karcioglu

Triponez

Solórzano

et al. 2023

JAMA Otolaryngol Head Neck Surg

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“…The procedure successfully allowed the patient to maintain calcium levels at goal with oral supplements, but the patient returned to her pre-bariatric surgery weight in the 3 years following the procedure. 20 This trade-off between restored calcium absorption and weight regain should be discussed with patients when choosing a surgical approach.…”

Section: Discussionmentioning

confidence: 99%

Refractory Hypocalcemia Following Stomach Intestinal Pylorus-Sparing Bariatric Surgery and Thyroidectomy: Successful Management With Creation of a Proximal Roux-en-Y Gastric Bypass

Jensen

Thompson

Machineni

et al. 2020

The American Surgeon

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Some forms of bariatric surgery make patients susceptible to calcium malabsorption, and the parathyroid hormone (PTH) axis is important for maintaining normocalcemia in these patients. Injury to the parathyroid glands due to anterior neck surgery commonly causes PTH axis disruption and can result in severe hypocalcemia in bariatric surgery patients. Herein, we present a case of a patient with a history of stomach intestinal pylorus-sparing bariatric surgery who developed refractory hypocalcemia requiring daily intravenous (IV) calcium 2 years after thyroidectomy. PTH levels were inappropriately normal during episodes of hypocalcemia, and urinary calcium level was <3.0 mg/dL following large oral doses of calcium, suggesting that both inadequate PTH response and malabsorption contributed to her severe hypocalcemia. In order to enhance calcium absorptive capacity while minimizing the risk of weight regain, she was surgically treated with a Roux-en-Y gastric bypass proximal to the prior operation. The surgery successfully improved blood calcium levels; the patient was successfully weaned from IV calcium and was able to maintain normocalcemia with oral supplements. We discuss the case in the context of available literature and provide our recommendations.

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Calcium-gluconate

2020

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Laparoscopic Revision of Bariatric Surgeries in Two Patients with Severe Resistant Hypocalcemia After Endocrine Cervical Surgery

Cited by 8 publications

References 10 publications

Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery

Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery

Refractory Hypocalcemia Following Stomach Intestinal Pylorus-Sparing Bariatric Surgery and Thyroidectomy: Successful Management With Creation of a Proximal Roux-en-Y Gastric Bypass

Calcium-gluconate

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