Acute Paralytic Post-Bariatric Surgery Axonal Polyneuropathy: Clinical Features and Outcome

Abstract

Introduction: The syndrome of post-bariatric surgery axonal polyneuropathy (PAP) may present with various sensory and motor symptoms including paralysis. We aim to describe the diagnostic features and outcome of treatment of the acute paralytic form of PAP (acute paralytic PAP [APPAP]) as it was not described in a separate cohort previously. Methods: We retrospectively reviewed medical charts and described the clinical, electrodiagnostic features, treatment, and outcome for patients who presented to our clinical neurophysiology unit with disabling weakness within 24 months post-bariatric surgery. The main outcome measure was the percent of patients who are able to walk independently at the last visit and comparing the group who resumed walking independently at 6 months to the group who did not, in regards to the use of intravenous immunoglobulin (IVIg). Results: Thirteen patients were included (10 women and 3 men) with a mean age of 29.8 years (SD 12.5). All presented with loss of ambulation resembling Guillain-Barre Syndrome. The median time of onset was 4 months (interquartile range [IQR] 3–6) post-surgery, and the median time to weakness nadir was 3 weeks (IQR 3–3.5) with an average weight loss of 38.6 kg (SD 17.09). All patients regained their ability to ambulate; however, the ability to walk independently was achieved in 66.7% of patients. The percent of patients who were able to ambulate independently at 6 months were 16% with IVIg versus 66.7% without IVIg. Conclusion: The syndrome of ­APPAP develops in the first-year post-bariatric surgery. The majority of patients regain independent ambulation.

Effect of COVID-19 pandemic on hospital admission rates of patients with malnutrition and/or neuromuscular complications after bariatric surgery

“…64 After SG, there is a risk of multivitamin/ mineral deficiencies due to poor food choices, food intolerance, microbiota changes, decreased hydrochloric acid, and intrinsic factors leading to B12 malabsorption. 11,[65][66][67][68][69] Regarding length of hospital stay, we found no differences before and during the pandemic. Patients with MC usually require prolonged hospitalisation for acute treatment, frequently followed by rehabilitation )56.3% of our sample underwent hospital rehabilitation(.…”

Prevalence, risk factors, and interventions for obesity in Saudi Arabia: A systematic review

“…Mortality rates were published. Of these papers, one was a case series, one cross‐sectional study, one prospective observational study, and six were retrospective audits 93–101 . Individual case reports were excluded.…”

“…The studies included one type of bariatric procedure 93,95,98,99,101 and compared complications across up to five different bariatric interventions 96 . There were four studies with no denominator 93,95,97,99 . These described 14 cases of acute pancreatitis after post‐intragastric balloon, 93,95 13 cases of acute axonal polyneuropathy, 98 and 42 cases of postoperative leak after sleeve gastrectomy 99 …”

“…Of these papers, one was a case series, one cross‐sectional study, one prospective observational study, and six were retrospective audits. 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 Individual case reports were excluded. The studies included one type of bariatric procedure 93 , 95 , 98 , 99 , 101 and compared complications across up to five different bariatric interventions.…”

“…96 There were four studies with no denominator. 93,95,97,99 These described 14 cases of acute pancreatitis after post-intragastric balloon, 93,95 13 cases of acute axonal polyneuropathy, 98 and 42 cases of postoperative leak after sleeve gastrectomy. 99 Collating data where a denominator of observed cases was provided totaled 1009 bariatric procedures.…”