Gastric Sleeve, Roux-en-Y and Nerve Damage

We all think bariatric bypass surgery is the answer to our weight loss problems. Sometimes, we just want to scream because of the long waits. Why can’t we just arrange a date and have done with it?

Well, besides the ridiculous provincial government designation of WLS being “elective surgery” resulting in it being at the bottom of the surgery wait lists, there are actually some medical reasons for taking a deliberate and unhurried approach.

Many pre-ops and post-ops often wonder about the need for extreme and the often lengthy period of counselling and education prior to surgery as well as the constant follow-up, usually for life. The short and simple of it is that we still don’t know all of the impact that bypass surgery has on the human body, particularly  long term ones. As an example, did you know that there is a high risk of developing neuropathy (nerve damage) in post-op Roux-en-Y and Sleeve bypass patients? This complication often doesn’t begin to show up until at least 5 years post-op.

As we discover more complexities associated to managing post-ops after bypass surgery, there is an increasing need for patients and their doctors to recognize and prevent the potential complications of weight loss surgery procedures. Neurological complications are one of the long term risks. Recent studies show that aggressive preventative measures and a team (Bariatric Centre of Excellence) 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 bypass surgery 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 bypass surgery, 26 (7%) developed PN. The authors observed the same three patterns of PN found previously; the majority were mononeuropathies (21 patients, 81%). 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 the 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 the care where there is a team of professionals supporting nutritional and psychiatric aspects of weight loss surgery.

You can tell if your surgeon is following best practices if they include referrals to nutritionists, endocrinologists and psychiatric/psychology resources and get them involved with patient care. Through a systematic, team approach of intensive pre- and postoperative nutritional management and frequent follow-up of patients undergoing bypass surgery, the development of this type of neuropathy complication 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

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