When general surgeon should call neurologist and what neurologist should know about obesity surgery?

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Abstract

Obesity is an ever-increasing problem all over the world and may associate with and cause many metabolic conditions. Bariatric surgery is recognized as the most effective procedure in losing weight, maintaining the weight loss over time and in reversing the associated comorbidities. However, surgery itself may cause some systemic complications due to limited food and micronutrient passage through the operated stomach. Up to 16% of the patients may develop complications involving any part of the nervous system. Neurological complications may develop immediately or long years after the surgery. Immediate post-operative complications are mononeuropathy/plexopathy and rhab-domyolisis. The common early complications are encephalopathy (in the form of Wernicke or Korsakoff encephalopathy), radiculoneuropathy mimicking Guillain-Barre syndrome and polyneuropathy. Optic neuropathy, myelopathy, peripheral polyneuropathy may develop over longtime course. Patients with these neurological complications are found to have isolated or multiple nutrient deficiencies of vitamins and minerals. Among all thiamine, B12 and copper deficiency ranks as the most common ones observed after surgery. Deficiencies of riboflavin, niacin, pyridoxine, folate, vitamin D, and vitamin E, iron, calcium, phosphorus, magnesium and trace elements such as zinc, iodine, and selenium have also been reported. Symptoms vary according to presentation time, anatomical location and injury mechanism. Occurrence of these neurological complications emphasizes the importance of patient education about adherence to nutritional suggestions and surveillance after surgery. Awareness and early intervention may prevent or heal these disabling and sometimes fatal complications.

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Demirci, S., & Doğan Ünlü, M. (2020). When general surgeon should call neurologist and what neurologist should know about obesity surgery? Turkiye Klinikleri Journal of Medical Sciences. Turkiye Klinikleri. https://doi.org/10.5336/medsci.2019-66555

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