Acute Polyneuropathies after Bariatric Surgery: Does Immunity Play A Role? Case series and Literature Review.

The incidence of bariatric surgery (BS) is on the rise, and the prevalence of complications associated with this procedure has also increased. The most common neurologic complications of BS are peripheral neuropathy and encephalopathy. In this study, we presented the clinical and electrophysiological courses of five patients with acute-subacute axonal polyneuropathy after BS. We evaluated neurological examinations, micronutrient deficiencies (B12, folic acid, thiamine, vitamin D), nerve conduction studies (NCS), and Guillain-Barré syndrome (GBS) disability scores. All patients were female; the average weight loss was 35.2 ± 7.52 kg, and the CSF protein level was 40.98 ± 6,99 mg/d. All patients underwent vitamin supplementation and physical therapies. The presence of more pronounced axonal involvement in NCSand the higher likelihood of normal CSF protein levels in BS-related acute polyneuropathy patients suggest that the underlying pathogenesis may differ from classical GBS. In the presented studies in the literature, inflammation is frequently observed in nerve biopsies of BS patients, suggesting that both micronutrient deficiencies and immune mechanisms play a role in the pathogenesis. Intravenous immunoglobulin (IVIG) treatment may improve neurologic deficits in patients with GBS-like clinical presentations. In the presented study, three patients were treated with IVIG, while two patients were treated with plasma exchange therapy followed by IVIG. Three cases improved significantly and were able to walk without assistance at one year visit. In patients with bariatric surgery (BS)-associated polyneuropathy, immunotherapy, and intensive pre- and post-operative nutritional management may improve patients' morbidity. Therefore, we suggest close monitoring by a multidisciplinary team for PBS patients.