Laparoscopic Sleeve Gastrectomy (LSG) & Neuropathy

Almaha Alsabah1, Salman Alsabah, MBA, FRCSC, FACS2, Waleed Renno, PhD1, Suleiman Alsabah, PhD1, Ahmed Alserri, PhD1. 1Kuwait University, 2Ministry of Health

INTRODUCTION: Laparoscopic Sleeve Gastrectomy (LSG) has gained popularity as the leading bariatric procedure for the treatment of morbid obesity. A serious complication of LSG is neuropathy, unfortunately, little is known in terms of its risk factors. Due to an increase in obesity and rising numbers of bariatric surgeries, neurologic complications have become increasingly recognized.

AIM: This study aims to examine the biochemical, hormonal, and genetic factors that are associated with neuropathy in patients post LSG.

MATERIALS AND METHODS: A retrospective study of 1700 morbidly obese patients who underwent LSG at Al-Amiri Hospital, Kuwait (2008-2014). 32 patients where included in the study; 16 patients with neuropathy, 16 patients without neuropathy. Diagnostic tools to determine the underlying causes of neuropathy including radiology reports, nerve conduction velocity (NCV) and physical examination as well as vitamin deficiencies. Moreover, blood samples to examine biomarkers through genetic analysis as well as hormones involved in neuropathy (GLP-1). DNA extraction and genotyping was performed by RT-PCR. Comparison between two groups was done by t test and Mann-Whitney Test.

RESULTS: The median age of neuropathic group is 33 (15 female, 1 male) while the control group was 25.5 (11 female, 5 male). Median onset of neuropathic symptoms was at 5 months after sleeve gastrectomy (3-18months). Median follow up for neuropathic group was 17 months while control group was 29 months. The neuropathic and control group’s median preoperative weight was 128kg (range 74-202kg) & 119kg (range 88-180kg), respectively with a median BMI of 48.5kg/h2 (range 39.7-63.3kg/h2) & 46.6kg/h2 (range 38.3-57.4kg/h2) respectively. T test of means for BMI showed no significance (P=0.1). There was no significant difference (p value 0.6) between two groups in regards to % excess weight loss post LSG at 12 months (61%,65%). B12 levels were different between the groups (p value 0.005), where means of vitamin b12 in neuropathic and control groups 336, 154 pg/mL, respectively. There was no significant difference in GLP1 levels between two groups (p>0.05value). Mean of GLP-1 in neuropathic and control groups were 2834 and 2880, respectively. A single nucleotide polymorphism (SNP) (rs6234) in the proprotein convertase (PCSK1) was investigated.

CONCLUSION: Our preliminary data showed neuropathic group lower levels of vitamin B12 post operatively and are older in age than the non-neuropathic group. There were no differences between patients who developed neuropathy after sleeve and those who did not in terms of preoperative BMI, excess weight loss % at 1 year, and GLP-1 levels. However, larger data is required to validate our results.

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