Acute Post-Gastric Reduction Surgery (APGARS) Neuropathy

Background: A variety of neurologic complications have been reported after weight loss surgery. Recently, a new term was introduced to describe cases of postoperative polyneuropathy - acute postgastric reduction surgery (APGARS) neuropathy, a polynutritional, multisystem disorder characterized by protracted postoperative vomiting, hyporeflexia, and muscular weakness. The incidence, associations, and prognosis of this disorder have not been precisely defined. Methods: A questionnaire about features of APGARS was mailed to all members of the ASBS. Surgeons were asked about their surgical and bariatric experience. Respondents were asked to report on specific cases where APGARS may have been present. They were also asked to report the patient's diagnosis and which operation the patient had undergone. Results: Of the 808 questionnaires, 257 were returned for a response-rate of 31.8%. The mean years in general surgical practice and in bariatric surgery were 15.3 ± 10.3 and 7.5 ± 7.4. A total of 168,010 bariatric cases were performed by all respondents. 109 cases of neuropathy were described. 99 cases were believed to represent APGARS (weakness with hyporeflexia and/or vomiting). Vitamin B₁₂ and/or thiamine deficiency were present in 40 (40%); 18 cases resolved. 9 of 17 cases with B₁₂ deficiency resolved; 12 of 29 cases with thiamine deficiency resolved; and 3 of 6 cases with both deficiencies resolved. Vitamin deficiencies were not noted in 59 (60%), of which 30 resolved. The most common diagnoses were Wernicke's encephalopathy, thiamine deficiency, and Guillain-Barré Syndrome. The most common operation performed was gastric bypass. Conclusions: The incidence of APGARS in this survey was 5.9 cases per 10,000 operations. Given the potentially reversible nature of APGARS, surgeons should be aware of the findings and treatment.