Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942008000300008
Brazilian Journal of Anesthesiology
Clinical Information

Polineuropatia periférica dolorosa após cirurgia bariátrica: Relato de casos

Painful peripheral polyneuropathy after bariatric surgery: Case reports

Miriam Seligman Menezes; Kelly O. Harada; Glauco Alvarez

http://dx.doi.org/10.1590/S0034-70942008000300008 Braz J Anesthesiol, vol.58, n3, p.252-259, 2008
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Resumo

JUSTIFICATIVA E OBJETIVOS: O número de pacientes submetidos à cirurgia bariátrica aumenta a cada ano com a ocorrência, cada vez mais freqüente, de complicações relacionadas com esse procedimento. As principais complicações relatadas são as complicações nutricionais, metabólicas, neurológicas e psicológicas/psiquiátricas. Dentre as complicações neurológicas destacam-se pela sua incidência as neuropatias periféricas. O objetivo desses relatos é chamar a atenção para esse tipo de complicação, que pode ter como manifestação inicial dor tipo neuropática, com posterior ou concomitante envolvimento motor e cujo prognóstico depende de diagnóstico e tratamento precoces. RELATO DOS CASOS: Foram relatados os casos de três pacientes, dois do sexo feminino e um do sexo masculino, submetidos à cirurgia bariátrica (método restritivo - bypass gástrico em Y-de-Roux) que evoluíram, no pós-operatório, com quadro de neuropatia periférica cujo sintoma inicial foi dor neuropática, com posterior ou concomitante envolvimento motor. As eletroneuromiografias demonstraram, nos três casos, uma polineuropatia periférica sensitivo-motora de padrão axonal. Em dois pacientes houve comprometimento intenso dos nervos fibulares. Todos tiveram em comum, antes da manifestação dos sintomas neurológicos, importante perda ponderal num curto período de tempo. CONCLUSÕES: As complicações neurológicas são uma das mais temíveis complicações da cirurgia bariátrica. Nenhum outro fator é mais importante na sua patogenia do que as deficiências nutricionais decorrentes da cirurgia. A vigilância nutricional, evitando-se perdas ponderais acentuadas e rápidas, e a reposição de suplementos são fundamentais para evitar as complicações, sobretudo os quadros neurológicos.

Palavras-chave

CIRURGIA, COMPLICAÇÕES, DOR

Abstract

BACKGROUND AND OBJECTIVES: The number of patients undergoing bariatric surgery increases every year, and the frequency of complications associated with this procedure has been increasing. The main complications reported are nutritional, metabolic, neurological, and psychological/psychiatric. Among the neurological complications, peripheral neuropathies are important due to their high incidence. The objective of this report was to stress the importance of this type of complication, in which the initial manifestation might be neuropathic pain followed or accompanied by motor involvement, and whose prognosis depends on early diagnosis and treatment. CASE REPORTS: The case of three patients were reported, two females and one male, who underwent bariatric surgery (restrictive method - Roux-en-Y gastric bypass) and developed, postoperatively, peripheral neuropathy with neuropathic pain as the initial symptom, with posterior or concomitant motor involvement. Electroneuromyography demonstrated in all three cases a sensitive-motor axonal peripheral neuropathy. In two patients, the fibular nerves were severely affected. In common, they all had an important weight loss in a short period of time before developing neurological symptoms. CONCLUSIONS: Neurological complications are one of the most feared complications of bariatric surgeries. Nutritional deficiencies secondary to the surgery are the most important factors in its pathogeny. Nutritional surveillance, avoidance of severe and fast weight loss, and nutritional supplements are fundamental to avoid complications, especially neurological complications.

Keywords

COMPLICATIONS, PAIN, SURGERY

Referencias

Pesquisa de Orçamentos Familiares: POF 2002-2003 - Análise da disponibilidade domiciliar de alimentos e do estado nutrional no Brasil. .

Gastrointestinal surgery for severe obesity: Consensus Development Conference Panel. Ann Intern Med. 1991;115:956-961.

Snow V, Barry P, Fitterman N. Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2005;142:525-531.

Singh S, Kumar A. Wernicke encephalopathy after obesity surgery: a systematic review. Neurology. 2007;68:807-811.

Machado FCN, Valério BCO, Morgulis RNF. Acute axonal polyneuropathy with predominant proximal involvement. Arq Neuropsiquiatr. 2006;64:609-612.

Harwood SC, Chodoroff G, Ellengerg MR. Gastric partitioning complicated by peripheral neuropathy with lumbosacral plexopathy. Arch Phys Med Rehabil. 1987;68:310-312.

Maryniak O. Severe peripheral neuropathy following gastric bypass surgery for morbid obesity. Can Med Assoc J. 1984;131:119-120.

Thaisetthawatkul P, Collazo-Clavell ML, Sarr MG. A controlled study of peripheral neuropathy after bariatric surgery. Neurology. 2004;63:1462-1470.

Alves LFA, Gonçalves RM, Cordeiro GV. Beribéri pós-bypass gástrico: uma complicação não tão rara. Relato de dois casos e revisão da literatura. Arq Bras Endocrinol Metab. 2006;50:564-568.

Abarbanel JM, Berginer VM, Osimani A. Neurologic complications after gastric restriction surgery for morbid obesity. Neurology. 1987;37:196-200.

Feit H, Glasberg M, Ireton C. Peripheral neuropathy and starvation after gastric partitioning for morbid obesity. Ann Intern Med. 1982;96:453-455.

Berger JR. The neurological complications of bariatric surgery. Arch Neurol. 2004;61:1185-1189.

Elias WJ, Pouratian N, Oskouian RJ. Peroneal neuropathy following successful bariatric surgery: case report and review of the literature. J Neurosurg. 2006;105:631-635.

Cruz-Martinez A, Arpa J, Palau F. Peroneal neuropathy after weight loss. J Peripher Nerv Syst. 2000;5:101-105.

Chang CG, Adams-Huet B, Provost DA. Acute post-gastric reduction surgery (APGARS) neuropathy. Obes Surg. 2004;14:182-189.

Fujioka K. Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care. 2005;28:481-484.

Bloomberg RD, Fleishman A, Nalle JE. Nutritional deficiencies following bariatric surgery: what have we learned?. Obes Surg. 2005;15:145-154.

Avinoah E, Ovnat A, Charuzi I. Nutritional status seven years after Roux-en-Y gastric bypass surgery. Surgery. 1992;111:137-142.

MacLean LD, Rhode BM, Shizgal HM. Nutrition following gastric operations for morbid obesity. Ann Surg. 1983;198:347-355.

Chaves LC, Faintuch J, Kahwage S. A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit. Obes Surg. 2002;12:328-334.

Attal N, Cruccu G, Haanpää M. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol. 2006;13:1153-1169.

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