Neurological Complications After Bariatric Surgery in Turkish People

Abstract

Clinicians might encounter with important neurological complications after bariatric surgery. These complications are often irreversible; thus, immediate diagnosis and appropriate treatment might improve neurological outcome. The objective of this study is to investigate neurological problems occurred after bariatric surgery. We attempted to improve the awareness of both clinicians and surgeons on the adverse neurological complications of bariatric surgery and management of these complications. This is a 1-year chart-based retrospective study of 705 patients who underwent bariatric surgery due to morbid obesity. All neurological complications were reviewed. Of the patients, 10 (1.4%) patients developed neurological complications including polyneuropathy, meralgia paresthetica, and peroneal mononeuropathy. There were 9 female and 1 male patients with an average age 28.9 years, ranging from 19 to 47 years. Herein, we reported some significant neurological complications after bariatric surgery in a large number of patient cohort. The percentage of patients who developed neurological complications (1.4%) is low compared with previous literature (ranging between 4.6% and 16%). Reporting this complication rate is important because the consequences of bariatric surgery may be debilitating to both clinicians and surgeons. The most important and frequent known cause of neurological complications is nutritional deficiency. Vitamin deficiency should be investigated at the earliest convenience and be treated quickly.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Fragoso YD, Alves-Leon SV, Anacleto Ade C, Brooks JB, Gama PD, Gomes S, et al. Neurological complications following bariatric surgery. Arq Neuropsiquiatr. 2012;70(9):700–3.

    Article  Google Scholar 

  2. 2.

    Berger G. Obesity and managed care. Manag Care Interface. 2007;20(5):36–7.

    PubMed  Google Scholar 

  3. 3.

    Becker DA, Balcer LJ, Galetta SL. The neurological complications of nutritional deficiency following bariatric surgery. J Obes. 2012;2012:1–8.

    Article  Google Scholar 

  4. 4.

    Koffman BM, Greenfield LJ, Ali II, Pirzada NA. Neurologic complications after surgery for obesity. Muscle Nerve. 2006;33(2):166–76.

    Article  Google Scholar 

  5. 5.

    Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4(5):73–108.

    Article  Google Scholar 

  6. 6.

    Matrana MR, Davis WE. Vitamin deficiency after gastric bypass surgery: a review. South Med J. 2009;102(10):1025–31.

    Article  Google Scholar 

  7. 7.

    Al-Sulaiman A. Acute painful polyneuropathy after bariatric surgery. Saudi J Med Med Sci. 2016;4(2):121–4.

    Article  Google Scholar 

  8. 8.

    Landais A. Neurological complications of bariatric surgery. Obes Surg. 2014;24(10):1800–7.

    Article  Google Scholar 

  9. 9.

    Algahtani HA, Khan AS, Khan MA, Aldarmahi AA, Lodhi Y. Neurological complications of bariatric surgery. Neurosciences (Riyadh). 2016;21(3):241–5.

    Article  Google Scholar 

  10. 10.

    Abarbanel JM, Berginer VM, Osimani A, Solomon H, Charuzi I. Neurologic complications after gastric restriction surgery for morbid obesity. Neurology. 1987;37(2):196–200.

    CAS  Article  Google Scholar 

  11. 11.

    Berger JR. The neurological complications of bariatric surgery. Arch Neurol. 2004;61(8):1185–9.

    Article  Google Scholar 

  12. 12.

    Yasawy ZM, Hassan A. Post bariatric surgery acute axonal polyneuropathy: doing your best is not always enough. Ann Indian Acad Neurol. 2017;20(3):309–12.

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Tabbara M, Carandina S, Bossi M, Polliand C, Genser L, Barrat C. Rare neurological complications after sleeve gastrectomy. Obes Surg. 2016;26(12):2843–8.

    Article  Google Scholar 

  14. 14.

    Juhasz-Pocsine K, Rudnicki SA, Archer RL, Harik SI. Neurologic complications of gastric bypass surgery for morbid obesity. Neurology. 2007;68(21):1843–50.

    Article  Google Scholar 

  15. 15.

    Krishnan P, Ramadas P, Landsberg D. Bariatric surgery causing hyperammonemia. Cureus. 2019;11(7):e5098.

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    Machado FCN, Valério BCO, Morgulis RNF, Nunes KF, Mazzali-Verstet S. Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery. Arq Neuropsiquiatr. 2006;64(3A):609–12.

    Article  Google Scholar 

  17. 17.

    Landais AF. Rare neurologic complication of bariatric surgery: acute motor axonal neuropathy (AMAN), a severe motor axonal form of the Guillain Barré syndrome. Surg Obes Relat Dis. 2014;10(6):85–7.

    Article  Google Scholar 

  18. 18.

    Halverson JD. Metabolic risk of obesity surgery and long-term follow up. Am J Clin Nutr. 1992;55(2 Suppl):602–5.

    Article  Google Scholar 

  19. 19.

    Hagman DK, Larson I, Kuzma JN, Cromer G, Makar K, Rubinow KB, et al. The short-term and long-term effects of bariatric/metabolic surgery on subcutaneous adipose tissue inflammation in humans. Metabolism. 2017;70:12–22.

    CAS  Article  Google Scholar 

  20. 20.

    Moschen AR, Molnar C, Geiger S, Graziadei I, Ebenbichler CF, Weiss H, et al. Anti-inflammatory effects of excessive weight loss: potent suppression of adipose interleukin 6 and tumour necrosis factor alpha expression. Gut. 2010;59(9):1259–64.

    CAS  Article  Google Scholar 

  21. 21.

    Holdstock C, Lind L, Engstrom BE, Ohrvall M, Sundbom M, Larsson A, et al. CRP reduction following gastric bypass surgery is most pronounced in insulin-sensitive subjects. Int J Obes. 2005;29(10):1275–80.

    CAS  Article  Google Scholar 

  22. 22.

    Bradley D, Conte C, Mittendorfer B, Eagon JC, Varela JE, Fabbrini E, et al. Gastric bypass and banding equally improve insulin sensitivity and beta cell function. J Clin Invest. 2012;122(12):4667–74.

    CAS  Article  Google Scholar 

  23. 23.

    Capel F, Klimcakova E, Viguerie N, Roussel B, Vitkova M, Kovacikova M, et al. Macrophages and adipocytes in human obesity: adipose tissue gene expression and insulin sensitivity during calorie restriction and weight stabilization. Diabetes. 2009;58(7):1558–67.

    CAS  Article  Google Scholar 

  24. 24.

    Belza A, Toubro S, Stender S, Astrup A. Effect of diet-induced energy deficit and body fat reduction on high-sensitive CRP and other inflammatory markers in obese subjects. Int J Obes. 2009;33(4):456–64.

    CAS  Article  Google Scholar 

  25. 25.

    Gonzalez-Plaza JJ, Gutierrez-Repiso C, Garcia-Serrano S, Rodriguez-Pacheco F, Garrido-Sanchez L, Santiago-Fernandez C, et al. Effect of Roux-en-Y gastric bypass-induced weight loss on the transcriptomic profiling of subcutaneous adipose tissue. Surg Obes Relat Dis. 2016;12(2):257–63.

    Article  Google Scholar 

  26. 26.

    Kratz M, Hagman DK, Kuzma JN, Foster-Schubert KE, Chan CP, Stewart S, et al. Improvements in glycemic control after gastric bypass occur despite persistent adipose tissue inflammation. Obesity (Silver Spring). 2016;24(7):1438–45.

    CAS  Article  Google Scholar 

  27. 27.

    Aghili R, Malek M, Tanha K, Mottaghi A. The effect of bariatric surgery on peripheral polyneuropathy: a systematic review and meta-analysis. Obes Surg. 2019;29(9):3010–20.

    Article  Google Scholar 

  28. 28.

    O’Brien PD, Hinder LM, Callaghan BC, Feldman EL. Neurological consequences of obesity. Lancet Neurol. 2017;16(6):465–77.

    Article  Google Scholar 

  29. 29.

    AlShareef A, Albaradei O, AlOtaibi HA, Alanazy MH, Abuzinadah AR. Acute paralytic post-bariatric surgery axonal polyneuropathy: clinical features and outcome. Eur Neurol. 2019;81(5-6):239–45.

    CAS  Article  Google Scholar 

  30. 30.

    Philippi N, Vinzio S, Collongues N, Vix M, Boehm N, Tranchant C, et al. Peripheral neuropathies after bariatric surgery. Laguna Rev Neurol (Paris). 2011;167(8-9):607–14.

    CAS  Article  Google Scholar 

  31. 31.

    Macgregor AM, Thoburn EK. Meralgia paresthetica following bariatric surgery. Obes Surg. 1999;9(4):364–8.

    CAS  Article  Google Scholar 

  32. 32.

    Jones CD, Luke Guiot L, Portelli M, Bullen T, Skaife P. Two interesting cases of meralgia paraesthetica. Pain Physician. 2017;20(6):987–9.

    Google Scholar 

  33. 33.

    Ramos-Leví AM, Jordi A, Matías-Guiu JA, Antonio Guerrero A, Andrés Sánchez-Pernaute A, Miguel A, et al. Peroneal palsy after bariatric surgery; is nerve decompresion always necessary? Nutr Hosp. 2013;28(4):1330–2.

    PubMed  Google Scholar 

  34. 34.

    Weyns FJ, Beckers F, Vanormelingen L, Vandersteen M, Niville E. Foot drop as a complication of weight loss after bariatric surgery: is it preventable? Obes Surg. 2007;17(9):1209–12.

    Article  Google Scholar 

  35. 35.

    Dong Q, Jacobson JA, Jamadar DA, Gandikota G, Brandon C, Morag Y, et al. Entrapment neuropathies in the upper and lower limbs: anatomy and MRI features. Radiol Res Pract. 2012;2012:1–12.

    Article  Google Scholar 

  36. 36.

    Oudman E, Wijinia JW, Van Dam M, Biter LU, Postma A. Preventing Wernicke encephalopathy after bariatric surgery. Obes Surg. 2018;28(7):2060–8.

    Article  Google Scholar 

  37. 37.

    Chang HW, Yang PY, Han TI, Meng NH. Ernicke Encephalopathy concurrent with polyradiculoneuropathy in a young man after bariatric surgery: a case report. Medicine (Baltimore). 2019;98(10):e14808.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Contributions

Esra Eruyar: logical interpretation and conclusion of the results, patient follow-up, collection of relevant biological materials, data management and reporting, execution of the experiments, necessary literature review for the study, writing of the whole or important parts of the study, and reviewing the article before submission scientifically besides spelling and grammar. Oktay Banli: constructing the hypothesis or idea of research and/or article, planning methodology to reach the conclusions, organizing, supervising the course of progress and taking the responsibility of the research/study, reviewing the article before submission scientifically besides spelling and grammar, and biological materials, taking responsibility of the referred patients.

Corresponding author

Correspondence to Esra Eruyar.

Ethics declarations

Ethics Approval

Ethics approval was taken.

Consent for Publication

Consent for publication was obtained from the patients.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Medicine

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Eruyar, E., Banli, O. Neurological Complications After Bariatric Surgery in Turkish People. SN Compr. Clin. Med. (2021). https://doi.org/10.1007/s42399-021-00789-4

Download citation

Keywords

  • Bariatric surgery
  • Neurologic complications
  • Nutritional