Turkiye Klinikleri Journal of Medical Sciences

.: REVIEW
When General Surgeon Should Call Neurologist and What Neurologist Should Know About Obesity Surgery?
Genel Cerrah Ne Zaman Nöroloğu Aramalı ve Nörolog Obezite Cerrahisi Hakkında Ne Bilmelidir?
Serpil DEMİRCİa, Melike DOĞAN ÜNLÜa
aSüleyman Demirel University Faculty of Medicine, Department of Neurology, Isparta, TURKEY
Turkiye Klinikleri J Med Sci. 2020;40(1):96-103
doi: 10.5336/medsci.2019-66555
Article Language: EN
Full Text
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 rhabdomyolisis. 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.

Keywords: Obesity; bariatric surgery; central nervous system diseases; peripheral nervous system diseases
ÖZET
 Obezite tüm dünyada giderek artan bir sorundur ve birçok metabolik bozukluğa neden olur veya bunlarla birlikte bulunabilir. Bariatrik cerrahi kilo vermede, zaman içinde kilo kaybını korumada ve ilişkili komorbiditeleri tersine çevirmede en etkili yöntem olarak kabul edilir. Bununla birlikte, ameliyatın kendisi ameliyat edilen mideden sınırlı yiyecek ve mikro besin geçişi nedeniyle bazı sistemik komplikasyonlara neden olabilir. Hastaların %16 kadarında sinir sisteminin herhangi bir bölümünü etkileyen komplikasyonlar gelişebilir. Nörolojik komplikasyonlar cerrahiden hemen sonra ya da yıllar sonra ortaya çıkabilir. Cerrahi sonrası hemen gelişen komplikasyonlar mononöropati/ pleksopati ve rabdomiyolizdir. Sık erken komplikasyonlar ensefalopati (Wernicke veya Korsakoff ensefalopatisi şeklinde), Guillain-Barre sendromunu taklit eden radikulonöropati ve polinöropatidir. Optik nöropati, miyelopati ve periferik polinöropati uzun dönemde gelişebilir. Bu nörolojik komplikasyonları olan hastalarda tek veya çoklu vitamin ve mineral eksiklikleri saptanabilir. Tiamin, B12 ve bakır eksikliği cerrahi sonrası en sık görülenlerdir. Riboflavin, niasin, piridoksin, folat, vitamin D ve vitamin E, demir, kalsiyum, fosfor, magnezyum ve çinko, iyot ve selenyum gibi eser elementlerin eksikliği de bildirilmiştir. Belirtiler ortaya çıkış zamanı, anatomik bölge ve hasar mekanizmasına göre değişebilir. Bu nörolojik komplikasyonların gelişimi cerrahi sonrası beslenme önerilerine uyum açısından hasta eğitimi ve gözetimin önemini vurgular. Farkındalık ve erken müdahale bu özürlendirici ve bazen ölümcül olabilen komplikasyonları önleyebilir veya iyileştirebilir.

Anahtar Kelimeler: Obezite; bariatrik cerrahi; santral sinir sistemi hastalıkları; periferik sinir sistemi hastalıkları
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