Stomach stapling and gastric bypass -- post surgical problems.

Translation: TAANSTAFL



AMA: Patients Who Undergo Gastric Bypass or Stomach-Stapling Should
Recognize Risk Of Nerve Injury Post-Surgery

Following nutritional guidelines and not losing weight too fast key to
prevention



ROCHESTER, MN -- October 14, 2004 -- Mayo Clinic researchers have found a
significant number of patients who undergo "stomach stapling" or gastric
bypass surgery for weight reduction develop peripheral neuropathy, damage to
any of the body's nerves outside of the brain and spinal cord. The
development of nerve damage is associated with malnutrition, and so the
researchers contend may be largely preventable with proper nutritional care.



"Surgeons who do weight-reduction surgery and the general public and should
be aware that nerve damage is a frequent consequence of the surgery," says
P. James (Jim) Dyck, M.D., Mayo Clinic neurologist and lead investigator in
this study, which will be presented at the American Medical Association
Science Reporters Conference on Oct. 14 and published in the Oct. 26 issue
of the journal Neurology. "I'm not saying that people shouldn't have this
surgery, but I am saying that there are real potential complications and
that good follow-up care is necessary."



The Mayo Clinic investigators found that 16 percent of weight-reduction
surgery patients they studied developed a peripheral neuropathy: nerve
problems ranging from minor tingling or numbness in the feet to severe pain
and weakness confining patients to wheelchairs.



"It's surprising how many of these patients developed peripheral
neuropathy," says Dr. Dyck. "Sixteen percent is a large number. But patients
who were part of nutritional programs before and after their weight loss
surgery generally didn't develop these neuropathies, so we believe the nerve
damage is largely preventable."



Dr. Dyck and colleagues identified risk factors in weight-reduction surgery
patients who later developed nerve problems: 1) they lost weight at a much
faster pace, 2) they received less nutritional supplementation, 3) they
experienced prolonged nausea and vomiting, and 4) they failed to attend
nutritional clinics.



"The evidence is very strong that nerve complications are associated with
malnutrition," says Dr. Dyck.



Some forms of malnutrition are well recognized to cause peripheral
neuropathy, such as thiamine deficiency in the disease beriberi. Rather than
the surgery being a direct cause of neuropathy, the associated rapid weight
loss and prolonged nausea and vomiting can lead to malnutrition and
neuropathy.



An important key to preventing peripheral neuropathy is to seek a robust
program with presurgical and postsurgical care by a multidisciplinary team
of specialists who can oversee the patient's nutritional status. "Don't just
choose a surgeon, choose a program," says Dr. Dyck. "Patients in our study
who were not part of programs were more likely to end up with nerve
problems. This is a life-changing operation. It's like having transplant
surgery -- you need long-term follow-up."



Michael Sarr, M.D., a Mayo Clinic weight-reduction surgeon who participated
in this study, adds, "It's a risky operation, but it's a calculated risk in
that morbid obesity is life threatening. Obesity can cause sleep apnea,
diabetes untreatable by insulin, excess fatty substances in the blood, and
coronary artery disease. Weight-reduction surgery shouldn't be taken
lightly, but it has tremendous benefit to select patients."



Dr. Dyck and colleagues embarked on this study due to a pattern they
observed in the peripheral neuropathy clinic. "We'd seen patients with nerve
problems in our clinic who'd had weight-reduction surgery," he says. "We saw
the association, and we wanted to test it in a scientific way."



The investigators searched the charts of 435 patients who had undergone
either Roux-en-Y gastric bypass or vertical banded gastroplasty, also known
as "stomach stapling," at Mayo Clinic or other medical institutions to
determine who later developed peripheral neuropathy. Three nerve disorders
were identified in the study patients: 1) sensory predominant neuropathy,
marked by pain and/or sensory loss, usually in the feet, 2) mononeuropathy,
involving individual nerves, as in carpal tunnel syndrome, and 3)
radiculoplexus neuropathy, marked by weakness, sensory loss and/or pain in a
patchy, multifocal way. Radiculoplexus neuropathy can have the most serious
consequences of the three, including confining a patient to a wheelchair.



To ensure that peripheral neuropathy was not linked to just any abdominal
operation, the team also identified a control group of 123 obese patients
who had undergone open gallbladder removal, another abdominal surgery. Only
3 percent of the control group developed a peripheral neuropathy.



"This is highly statistically significant," says Dr. Dyck. "We believe that
the peripheral neuropathy relates specifically to the weight-reduction
surgery and not just any type of abdominal surgery."



Dr. Dyck and colleagues have not yet studied whether these nerve problems
are reversible. "We don't know what the long-term outcomes will be for these
patients," he says. "Nerves can regrow, and there are people who have
improved."



According to Dr. Dyck, this is the largest and most systematic identifying
patterns of neuropathy in weight-reduction surgery patients. It also is the
first to use a control group to look for an association between weight-loss
surgery and nerve problems, and the first to identify risk factors for
developing peripheral neuropathy.





SOURCE: Mayo Clinic



http://www.docguide.com/news/content...rgery&count=10

One time on Usenet, "Patricia Heil" said:

Translation: TAANSTAFL

AMA: Patients Who Undergo Gastric Bypass or Stomach-Stapling Should
Recognize Risk Of Nerve Injury Post-Surgery

Following nutritional guidelines and not losing weight too fast key to
prevention

snip

http://www.docguide.com/news/content...5256F2D0051F08
2?OpenDocument&id=48DDE4A73E09A969852568880078C249 &c=Surgery&count=10

I've said it before and I'll say it again -- thank God I didn't
have that kind of surgery. It make take me a while longer to hit
my ultimate goal, but I'll be in great shape when I get there...


--
J.J. in WA * 275/232.5
Goal #2: 215 By Dec 31 '04
Goal #3: 195 by May 31 '05

"Ignoramus32597" wrote in message
...
Thanks for posting this. Would be interesting to compare total
mortality among bariatric surgery patients with similarly obese
controls who were not operated, over a few years.

Malnutrition was present in 5% of patients, according to article
15018745, and edema (extreme swelling) was present in 45%.

i

I guess the important message is make sure your doctor understands these
things so that you can be sure s/he's giving you the right post-surgical
instructions, and then do what you're told.

"Ignoramus32597" wrote in message
...
Thanks for posting this. Would be interesting to compare total
mortality among bariatric surgery patients with similarly obese
controls who were not operated, over a few years.

Malnutrition was present in 5% of patients, according to article
15018745, and edema (extreme swelling) was present in 45%.

i

I guess the important message is make sure your doctor understands these
things so that you can be sure s/he's giving you the right post-surgical
instructions, and then do what you're told.