Good Nutritional Control May Prevent Polyneuropathy After Bariatric Surgery

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With the rising popularity of bariatric surgery (BS), there is an increasing need for patients and their doctors to recognize and prevent the potential complications from this weight loss procedure. Neurological complications are one of the risks, and recent studies show that appropriate preventative measures and a multidisciplinary approach can largely prevent the development of postoperative nerve damage, also known as peripheral neuropathy (PN).

In previous studies, researchers showed that PN can occur after bariatric surgery and be of three types: mononeuropathy, sensory predominant polyneuropathy, and radiculoplexus neuropathy. Malnutrition was the major risk factor for sensory predominant polyneuropathy but not the other subtypes. Nutritional deficiencies can occur following BS due to patients not taking multi vitamins, experiencing more weight loss than expected, and post operative complications.

The authors performed a retrospective, cohort study in all patients having BS at a select clinic between 1985 and 2002, with follow-up. 

Potential risk factors were analyzed using life table methods. Of 393 eligible patients with BS, 26 (7%) developed PN. The authors observed the same three patterns of PN found previously; the majority were mononeuropathies (21 patients, 81%). Univariate life table analysis showed the following risk factors: increased serum glycosylated hemoglobin and triglycerides, prolonged duration of hospital stay, postoperative gastrointestinal symptoms, as well as nausea and vomiting. PN occurred less frequently and specifically the sensory predominant polyneuropathy subtype occurred less frequently than in a prior cohort.

As described by researcher, Dr. P. James B. Dyck, neurologist at Mayo Clinic in Rochester, Minnesota, “At Mayo Clinic, we insist that patients eligible for bariatric surgery undergo nutritional consultations, and a psychiatric assessment prior to surgery to make certain their nutrition is addressed. Patients attend nutritional clinics 6 months prior to surgery and multivitamins are taken by all patients scheduled to undergo this procedure.” Fellow researcher, Dr. Pariwat Thaisetthawatkul added, “This is a message of prevention, this study really emphasizes this. Patients should be aware that PN is a risk of BS and seek their care where there is a multidisciplinary approach to their treatment. Surgeons performing this procedure should include the nutritionists and endocrinologist on staff and get them involved with the patient care. Through a systematic, multidisciplinary approach of intensive pre- and postoperative nutritional management and frequent follow-up of patients undergoing BS, the development of this type of neuropathy can largely be prevented.”

The complete findings and results of this study are being presented at the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) 56th Annual Meeting in San Diego, California, at the Manchester Grand Hyatt, October 7-10, 2009. With over 5000 members, the AANEM is the world’s largest organization dedicated to advancing neuromuscular, musculoskeletal, and electrodiagnostic medicine.

Source:  American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM)

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