A controlled study of peripheral neuropathy after bariatric surgery

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Abstract from Neurology. 2004 Oct 26;63(8):1462-70.

A controlled study of peripheral neuropathy after bariatric surgery.

Thaisetthawatkul P, Collazo-Clavell ML, Sarr MG, Norell JE, Dyck PJ.

Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN 55905.

BACKGROUND: Although peripheral neuropathy (PN) occurs after bariatric

surgery (BS), a causal association has not been established.

OBJECTIVES: To ascertain whether PN occurs more frequently following BS

vs another abdominal surgery, to characterize the clinical patterns of

PN, to identify risk factors for PN, and to assess if nerve biopsy

provides pathophysiologic insight.

METHODS: Retrospective review identified patients with PN after BS. The

frequency of PN was compared with that of an age- and gender-matched,

retrospectively evaluated cohort of obese patients undergoing

cholecystectomy. RESULTS: Of 435 patients who had BS, 71 (16%) developed

PN. Patients developed PN more often after BS than after cholecystectomy

(4/126; 3%) (p < 0.001). The clinical patterns of PN were polyneuropathy

(n = 27), mononeuropathy (n = 39), and radiculoplexus neuropathy (n =

5). Risk factors included rate and absolute amount of weight loss,

prolonged gastrointestinal symptoms, not attending a nutritional clinic

after BS, reduced serum albumin and transferrin after BS, postoperative

surgical complications requiring hospitalization, and having jejunoileal

bypass. Most risk factors were associated with the polyneuropathy group.

Sural nerve biopsies showed prominent axonal degeneration and

perivascular inflammation.

CONCLUSIONS: Peripheral neuropathy (PN) occurs more frequently after

bariatric surgery (BS) than after another abdominal surgery. The three

clinical patterns of PN after BS are sensory-predominant polyneuropathy,

mononeuropathy, and radiculoplexus neuropathy. Malnutrition may be the

most important risk factor, and patients should attend nutritional

clinics. Inflammation and altered immunity may play a role in the

pathogenesis, but further study is needed.