Lesson of the Week: Wernicke's encephalopathy after vertical banded gastroplasty for morbid obesity

Seehra, H; Macdermott, N.; Lascelles, R. G.; Taylor, T Vincent

doi:10.1136/bmj.312.7028.434

Cited by 77 publications

(38 citation statements)

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“…Folic acid deficiency is less frequent and is in direct relation to severe food intake reduction and fast loss of weight (MacLean et al, 1983). Thiamin deficiency, sometimes already present in obese people before bariatric surgery, has been described in VBGM (Seehra et al, 1996;Houdent et al, 2003), and in AGB procedures (Quar Bozbora et al, 2000). It is due to a reduction of gastric acid secretion and food restriction associated with vomiting.…”

Section: Discussionmentioning

confidence: 99%

Weight loss and quality of life after bariatric surgery: a study of 200 patients after vertical gastroplasty or adjustable gastric banding

et al. 2007

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Background and objectives: Long term evaluation of bariatric surgery must include quality of life measurement. Methods: Quality of life (QoL) was evaluated using the original Moorehead-Ardelt questionnaire for 200 patients operated for massive obesity in a single centre between 1994 and 2003. QoL and physical data were obtained by retrospective mail questionnaire. Surgical procedures were vertical-banded gastroplasty according to Mason (VBGM) and adjustable gastric banding (AGB) in 61 and 39% of patients, respectively. The aim of the study was to assess the nutritional outcome and QoL according to the procedure. Results: Overall, the body mass index (BMI) decreased from 5078 kg/m 2 before surgery to 35.277.5 kg/m 2 at the time of the questionnaire. The percentage of weight loss was 28.8712.2%. In the group treated with VBGM, the mean initial weight (P ¼ 0.003) and the percentage of weight loss (Po0.001) were significantly higher, and the QoL was better (P ¼ 0.003) than in the group treated with AGB. On the basis of the time spent since surgery, a regular weight loss was observed during the first 5 years, whereas weight subsequently increased over the five following years. Similarly, the total QoL score gradually improved during the first 5 years and worsened thereafter. However, it remained better than before surgery. A linear regression analysis showed a positive correlation between the percentage of weight loss and the QoL score (Po0.001).Conclusions: This study suggests that the bariatric surgery, particularly the VBGM technique, improved the QoL of obese patients, at least in the first 5 years following surgery.

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Section: Discussionmentioning

confidence: 99%

Weight loss and quality of life after bariatric surgery: a study of 200 patients after vertical gastroplasty or adjustable gastric banding

et al. 2007

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“…An intragastric migration of the polypropylene band restricting the gastric outlet, or ulceration of the stoma, have also been reported, but remain rare. Nutritional deficiencies are seldom encountered after vertical banded gastroplasty, despite the considerable restriction of nutrient intake, described by some authors 28 as a state of 'starvation in the midst of plenty'.…”

Section: Gastric Surgery -Related Risks and Complicationsmentioning

confidence: 99%

“…While low serum iron and ferritin levels are frequently observed after gastroplasty 15 , there is usually no fall in hemoglobin level or in the number of blood red cells. Thiamine deficiency, with neurological sequelae, may also occur 28 ' 29 , especially in subjects suffering from intractable vomiting. If intravenous glucose is administered, it may exacerbate the problem by increasing demand for thiamine 28 .…”

Section: Gastric Surgery -Related Risks and Complicationsmentioning

confidence: 99%

“…Thiamine deficiency, with neurological sequelae, may also occur 28 ' 29 , especially in subjects suffering from intractable vomiting. If intravenous glucose is administered, it may exacerbate the problem by increasing demand for thiamine 28 . The most threatening early complication of gastric bypass is an anastomotic leak, which, according to some reports 9 , occurs in up to 4% of patients.…”

Section: Gastric Surgery -Related Risks and Complicationsmentioning

confidence: 99%

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Surgical treatment for morbid obesity

Kolanowski

1997

British Medical Bulletin

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Since severe obesity is frequently associated with serious metabolic, cardiovascular and psychological co-morbid conditions, and given the usually unsuccessful results of conservative therapeutic approaches, surgical treatment based on gastric restriction procedures is increasingly recognized as a treatment of choice for morbidly obese persons. Among several surgical approaches designed to promote a substantial loss of weight, two gastric restriction procedures, i.e. the vertical banded gastroplasty and the gastric bypass, have been increasingly used during the past years. Both techniques induce an impressive loss of weight, and are surprisingly well tolerated, even by severely obese persons.The usual 50-75% reduction of initial weight excess, is followed by a clear-cut reduction, or even disappearance of, obesity-related co-morbidity, such as hypertension, diabetes mellitus or sleep apnea syndrome.While serious peri-and postoperative risks are very limited, the intractable vomiting occurring after gastroplasty, and potential sequelae related to iron and calcium malabsorption after the gastric bypass, represent much more frequent complications of the surgical treatment of obesity. There is also a tendency towards a late regain of weight, but the benefit in terms of improvement in the obesity-associated co-morbidity is in general maintained despite this partial increase in weight.Gastric procedures are, therefore, an effective treatment of severe obesity and of its co-morbid conditions. However, careful medical and nutritional supervision is necessary during the follow-up after surgery, to prevent potential nutritional or digestive complications.

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“…5,6 It is, however, unclear from these studies what level of dietary advice, if any, was given to subjects preoperatively or at follow-up. Nutritional supplementation is increasingly being advised for all patients who undergo gastric restrictive surgery, 4,6,7 but details of compliance are often not recorded or reported.…”

Section: Introductionmentioning

confidence: 99%

Nutritional consequences of modified vertical gastroplasty in obese subjects

et al. 1999

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BACKGROUND: Gastroplasty results in a considerable reduction in food intake and dramatic weight loss. This is likely to have a nutritional impact, although it is expected that this may be minimised by good advice and supplement use. METHODS: Twenty six obese subjects were studied in detail before and after modi®ed long vertical gastroplasty (MLVG), in a setting where comprehensive nutritional advice on symptom avoidance was readily available and multivitamin supplements advised. Nutritional intake and anthropometry were measured preoperatively and at 2, 5 (n 22) and 12 months (n 11) postoperatively. RESULTS: Mean weight loss was 13%, 22% and 31% of initial body weight at the respective time points. Energy intake (EI) was signi®cantly reduced postoperatively, with the mean protein intake being only 40 gad. At 2 months, mean intakes of iron, calcium and zinc from food were 40%, 71% and 39%, respectively, of the Australian recommended dietary intake (RDI), and iron and zinc intake remained below half the RDI at 5 months. Only regular adherence to the vitaminamineral supplement, brought iron and calcium intakes close to RDI, but zinc remained low. Haemoglobin and serum ferritin concentrations did not alter signi®cantly and remained within the reference range, but serum folate fell signi®cantly between 5 months and 12 months. By 5 months, 60% of subjects never regurgitated or regurgitated less than once a week. Fresh bread was the least tolerated food. Frequency of regurgitation was not correlated with adequacy of nutrient intake. CONCLUSIONS: The results emphasise the need for regular follow-up of MLVG patients, and nutritional advice which includes diet quality as well as symptom management, and regular intake of the vitaminamineral supplement for at least a year postoperatively. Low protein intakes, however, remain of potential long-term concern.

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Lesson of the Week: Wernicke's encephalopathy after vertical banded gastroplasty for morbid obesity

Cited by 77 publications

References 5 publications

Weight loss and quality of life after bariatric surgery: a study of 200 patients after vertical gastroplasty or adjustable gastric banding

Weight loss and quality of life after bariatric surgery: a study of 200 patients after vertical gastroplasty or adjustable gastric banding

Surgical treatment for morbid obesity

Nutritional consequences of modified vertical gastroplasty in obese subjects

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