Wernicke Encephalopathy in Subjects Undergoing Restrictive Weight Loss Surgery: A Systematic Review of Literature Data

Abstract

The use of weight loss surgery is progressively increasing, and in recent years, restrictive bariatric surgery procedures have been more often used. Although thought to be associated with a lower incidence of post-operative side effects than malabsorpitive surgery, some cases of micronutrients deficiency have been reported because of an acquired thiamine deficiency; in this clinical setting, some cases of Wernicke encephalopathy (WE) have been described. Major determinants and predictors of this major neurological complication are currently unknown. The aim of this systematic review was to analyse literature data in order to address this issue. The main result of our systematic review was that persistent vomiting is the major determinant of WE in patients undergoing restrictive weight loss surgery. In addition, early thiamine supplementation can rapidly improve the clinical conditions, avoiding permanent deficiencies. On the other hand, given the wide variability of clinical and demographic characteristics, definite prognostic factors of WE occurrence and of clinical outcome cannot be identified. In conclusion, although our results are suggestive, further ad hoc prospective studies evaluating changes in micronutrients levels according to different types of surgery are needed.

Lipid profile changes in patients undergoing bariatric surgery: A comparative study between sleeve gastrectomy and mini-gastric bypass

“…At the time of hospital discharge all patients received a specific nutritional program based on a hypochaloric diet and on adequate micronutrient supplementation [17,18].…”

Beriberi: an uncommon complication of sleeve gastrectomy

“…The deficiency in thiamine could manifest itself as either beriberi, if there is peripheral polyneuropathy (7) , or as Wernicke-Korsakoff syndrome, in which acute neurological symptoms manifest as ataxia, ophthalmoplegia, nystagmus, confusion and hallucinations arise (3,4,9,10) . In the case of bariatric beriberi it is characteristic for the symptoms to appear 4-12 weeks post-operatively in patients whom have presented with vomiting during this time (3,7,9) .…”

“…In the case of restrictive techniques, these are due to the decrease in ingestion, its poor quality and the presence of vomiting in postoperative stage. Numerous studies conclude that persistent vomiting is the major determinant of malnutrition in patients undergoing restrictive weight loss surgery (4,5,6,7) . This is a rare complication and has no association with the gradual weight loss which patients experience post restrictive bariatric surgeries.…”

Complications in Bariatric Surgery

“…A patient returning to the hospital because of intractable vomiting in the early weeks after bariatric surgery is at risk of developing thiamine deficiency. It can cause irreversible neurologic changes, with confusion, ataxia and nystagmus (Wernicke's encephalopathy) as well as heart failure [40].…”