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March 20, 2006

Gastric Bypass risk of Nerve Injury

BadnerveMayo 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
  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 pre-surgical and post-surgical 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.

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Comments

Marilyn

Hi i just wanted to say thank you for your site ... i had gastric bypass surgery roux en y January 2003 got down to 465lbs from well over 700lbs ... my weight is extreme i know ...but i wanted to comment because i have peripheral neuropathy ... the explanation i received was due to my long stay in ICU and on a ventilator ... my mom always held the hospital responsible but i never wanted to blame anyone after all they did me a great service performing the surgery saving my life, but after reading this study ... i'm not sure what to think ... Just wanted to say thanks and to wish you the very best on Your journey ... Take Care & Be Well ...

TheMorbidMe

Dear Marilyn! Thank so much for your comment.... I do hope you are doing fine! One of my best friends is a Neurologist and I will write more about this topic soon! Thanks !

DEBBIE

MY DAUGHTER IS 25 YEARS OLD AND IS NOW IN A WHEEL CHAIR. SHE WAS ADMITTED INTO THE HOSPITAL WITH A "STOMACH VIRUS" AND NOW SHE CANT WALK. SHE HAD GASTRIC BYPASS ON DEC 12, 2005. SHE WAS DOING GREAT UNTIL THE VOMITING STARTED. THE GASTROLOGIST WHO DID THE SURGERY IS THE ONE WHO ADMITTED HER TO THE HOSPITAL. HE NEVER TESTED HER VITIMAN LEVELS UNTIL AFTER SHE HAD BEEN SENT HOME AND FELL. SHE HAD BEEN COMPLAINING OF NUMBNESS IN HER HANDS, FEET, LEGS AND ARMS ALMOST IMMEDIATLY AFTER SHE WAS ADMITTED INTO THE HOSPITAL. I HAVE BEEN TOLD THAT IF PROPER TEST HAD BEEN DONE AND PROPER VITIMANS AND NUTRITION AND BEEN GIVEN TO MY DAUGHTER SHE WOULD STILL BE ABLE TO WALK. INSTEAD, HE LET HER LAY THERE FOR 11 DAYS VOMITING. BE SURE THAT YOUR SURGEON KNOWS HOW TO TAKE CARE OF YOU AFTER YOUR SURGERY. I AM NOT SORRY THAT SHE HAD THE SURGERY, I JUST WISH SHE HAD A DOCTOR WHO KNOWS HOW TO TAKE CARE OF HIS PATIENTS AFTER THE SURGERY.

Nancy Donlon

I had Gastric Bypass 3 years ago. I woke up one morning and my hands and feet were numb. I now have permanent peripheral neuropathy, probably from a thiamine and B-12 deficiency. I was a dental hygienist and can no longer perform my job. I also have become an alcoholic. No one warned me about these possible complications.

Jackie Bennett

I had Gasric bypass surgery in 2003 and lost the feeling in my right leg I was told that I would I probely would not get the feeling back and would have to walk with a cane. I went through 6 months of physical therepy and shock treatments and I worked and worked on my leg and exercised and I have all the feeling back in my leg now I do not walk with a cane and I am doing very well. I was low on vitamin b12 and thiamin and I go in once a month for a shot of b12 and I take thiamin pills so that I do not loose the feeling again. was the surgery worth it? yes it was I have a new life and I love it! I feel I could die over weight or I could have died from the surgery either way it was in gods hands.

fern

i had gastric bypass in 2000 and now i have extreamly low potassium calcium and vitiman d
i have all ways taken 1000mg of vitiaman d and calcium but im not absorbing any of them wich is causing health problems
gastric bypass is new. what are the problems that have rissen since. i have problems absorbing any medications and vitimans what information is out there concerning this problem

Kristy

I had gastric bypass on 11/8/06. I was at my highest 270 and now I'm down to 179. I have not had any complications, except for the vomiting the first 2 months of getting used to the small amounts of food. I never felt better!! I hear stories about people who have had this surgery have become alcoholics afterwards. How true is this? Is there something that I can read up on that can verify it? I admit, I go out a lot more now than I ever did, but only because I am more confident in myself. Yes I have a drink every once in a while, but I don't feel the need to drink all the time. I never was a big drinker before, and I don't think that I am now. My mother and my sister-in-law are concerned for me. Anyone got any info for me to let them sleep a little easier at night??

becci

I had gastric bypass 3 and a half years ago and for the last year have had tingling in my forearms and hands, now i have symptoms of restless legs sydrome, docs have found nerve damage in my neck but have not looked further. i wonder if this is neuropothy?

Kathy

I had roux-en-Y in September 2006 and have lost 120 pounds. A few weeks ago, I lost some sensation in my right calf and top of the foot, and a nerve study found mild neuropathy in both legs. I'll be tested for vitamin deficiencies in a couple of weeks at my one-year surgical follow-up. I found it especially interesting that the study concluded that neuropathy was not typically found in patients who had nutritional counseling as part of their surgical program. If that's true, then I'm an exception because my program included thorough nutritional counseling. I've met with the dietitian six times over the past year (three pre-op and three post-op consultations). I've been taking a multivitamin regularly and have eaten a decent diet, so the neuropathy diagnosis surprised me. I hope the link between neuropathy and gastric bypass will be studied further and that doctors will alert patients about symptoms to watch for.

Meagan

I am also suffering from severe neuropathy six years after Roux-en-Y gastric bypass. I have taken my vitamins regularly so this is a real blow. :(

Diane

I had RY Gastric Bypass 13 months ago. I have lost 114 pounds. 7 months ago, I had a tingling/numbing in two fingers of left hand to my elbow. A month later, my right leg and top of foot became numb resulting in "foot drop". I had 6 weeks of therapy and thank the Lord, I can walk again without that painful gait and not have to wear a special orthotic. By the way, the orthotic for my arm cost $700.00. The special brace for my right leg was over $850.00. A month after the right one went numb, the left one did as well. Fortunately, the left one has not developed the foot drop. My neurologist hasn't even mentioned this stuff to me. He increased my anti-depression medication, gave me a prescription for a topical gel to ease my muscle cramps, patted me on the head and said see ya in 3 months. I really couldn't believe he said that. My GBYP Surgeon hasn't said much either. Maybe I need a new gastric surgeon and a new neurologist. I also had nutritional counseling and have been taking all my required vitamins and calcium and vitamin D. I have been tested for malnutrition and vitamin deficiencies and a bunch of other things as well and no one can tell me what is causing this neuropathy. I don't generally vomit unless I overeat and I feel fine otherwise. So, these specialists need to look further into the causes because there are those of you out there like me who are the exception to the rule. I've been very aggressive with my doctors about this, but I see I must get more aggressive or this thing could remain permanent and that would be very difficult to deal with.

sandra

after reading your posts about some of the side affects, i am relieved to know i'm not the only one. I had my surgery in aug 4,2009.by march 2010 i ws already down to 150 pounds,as of today im138. but a few months ago i started falling ang tripping over my left foot, i was immediatly hospitiized for nerve injury to my lower left leg, called periphreal neuropathy..by the way im only 34, and tried to be very active sice i missed alot out of my kids life. right now i am going under further testing, bus in addition to the bypass i also suffer from grave;s disease which doesn't help much. but the neurologists immediate conclusion is losing over a 1oo months in 7 months..not sure what to do..any ideas?

sandra

sorry i meant losing 100 pounds in 7 months...correcton

dyan

I had my gastric bypass in October 09. In July 10, i noticed i was tripping over my left foot, my MD said it was "drop foot' and sent me to a specialist. In Novemver 10 i fell flat on my face and knocked myself out, this is when i realized i had two numb feet. The specialist said it was a side effect of the bypass operation. i have regained some feeling and strength in my feet and could have a complete recovery. the numbness may not totally go away. I had all the proper nutritional counciling and take all the supplements, b12, multi vit, D..everything. I went from a size 22XXX to a size 6. I never feel hungry so have to remind myself to eat (5 small meals a day). I am still gratefull for the operation. But i do have to be aware when walking.

dana

had my gastric bypass in may 06 had an auto accident that sept. ever since then i have had serve neck and back problems. it has gootan so bad now i have had to go to a nerologist. it really upsets me because i have had to pain management even had to go to rehab due to several withdrawls kept telling family and doctors something was going on but wouldnt listen now im 36 two kid single two jobs and i hurt extremly i need some advice please

Debra

hello
had gastric bypass surgery on 9-2-10. prior to surgery had periipheal neuropathy in both legs from diabetes. Since the surgery I hae developed foot drop and have been tripping over my own feet. Getting leg cramps bad and the pain in the legs are so different from before. Real different feelings. Hard to explain. going to see a neurologist next week for a nerve conduction test. NOt sure what will happen but been going to therapy. Just have to wait and see. Thought I was the only one with this problem. Very upset because I feel so wonderful. I have lost 80 lbs. and did have vit. b-12 real low. Took shots and take b-12 sublingual daily. Hands are going numb also. Very discouraging after losing all that weight and now these problems. I knew something was wrong when the feelings in my feet were different.

Lucy

I had a gastric sleeve which is actual removal of the stomach fundus 6 weeks ago and I m getting numbness in my feet already. I had no idea this could happen to me. I would have rather stayed heavy.

RN David

Congratulations with your achievement and continue to inspire others. I am a private nurse and we have a senior patient who is morbidly obese, his doctor do not recommend surgery with his age. Roca Labs gastric bypass no surgery was advised as alternative and works safely. He is recovering his healthy weight with an average of 2-3 lbs a week. Saved himself from sugical cost and complications. What's good is, there is no diet nor restrictions. Whichever way, best of luck!

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