Neurological complications of bariatric surgery

Abstract

Objective: To review and analyze the neurological complications from bariatric surgery in Kingdom of Saudi Arabia.

Methods: This cross sectional study was carried out in King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia from January 2009 to December 2015. Important personal and clinical data were collected from the charts of the patients who underwent bariatric surgery. Data on follow up visit and remote complication if present, was also collected. All patients with neurological complications were reviewed in detail. The significant difference was calculated by using T-test and p-value<0.05 was considered significant.

Results: A total of 451 patients underwent bariatric surgery, 15 cases had neurological complications (3%). Axonal polyneuropathy was the most frequent neurological complication, but cases of Wernicke syndrome, vitamin B12 deficiency, Guillain-Barre syndrome and copper deficiency were also identified. Fourteen patients (93.3%) had full recovery from the neurological signs and symptoms; one patient died.

Conclusion: Bariatric surgery is not free of potential neurological complications. Complications may affect both central and peripheral nervous system and death is a possibility. Multidisciplinary care including consultation of different teams is highly recommended.

Figure 1

Magnetic resonance imaging brain of one of our patients who developed Wernicke’s encephalopathy following BSP. Images shown are axial images at the level of thalami (A, B, and C) and midbrain (D and E). Sequences are FLAIR images (A and D), T2 WI (B and E) and diffusion image (C). Images show high signal intensity in the medial thalamic nuclei and tectal plate. BSP- bariatric surgical procedures, FLAIR - fluid-attenuated inversion recovery

Figure 2

Simple drawing of different types of BSP. BSP - bariatric surgical procedures, BPD - biliopancreatic diversion