Lale Azmi, Kirkil Cuneyt, Ozturk Sait, Yur Mesut, Can Omer Faruk, Artaş Gokhan, Aygen Erhan
Department of General Surgery, Fırat University Medical Faculty Hospital, Elazığ, Turkey.
Department of General Surgery, Fırat University Medical Faculty Hospital, Elazığ, Turkey.
Surg Obes Relat Dis. 2020 Nov;16(11):1684-1691. doi: 10.1016/j.soard.2020.06.054. Epub 2020 Jul 15.
The loss of the fat pad surrounding the fibular head after rapid and excessive weight loss after bariatric surgery can lead to foot drop symptoms due to peroneal nerve entrapment (PNE). Conservative and surgical approaches have been described for the treatment of this condition, but there is some controversy over the effectiveness of the treatment modalities.
We aimed to investigate the causes and frequency of foot drop due to PNE after bariatric surgery and to investigate the effects of peroneal nerve decompression (PND) as a surgical treatment for PNE.
Single center, university surgical department.
We retrospectively evaluated a series of 2607 patients in terms of neurologic complications after bariatric surgery. Patients' age, sex, co-morbid diseases, vitamin and electrolyte levels, body mass index and postoperative excess weight loss, affected limb, duration of symptoms, and muscle strength scores (according to the Medical Research Council scale) were recorded.
A total of 14 (.5%) patients had foot drop symptoms due to PNE. Of these patients, 9 underwent PND. The mean excess weight loss of PND patients at postoperative months 6 and 12 were 68.8 ± 13.5 and 100.9 ± 10.8, respectively. Foot drop symptoms became evident 5 to 11 months after bariatric surgery, affecting only a unilateral lower extremity in all patients. In laboratory analysis, there were no signs of nutritional and vitamin deficiency or insufficiency in any of the PND cases. Muscular strength was Medical Research Council grade 0 in all patients. The median duration of symptoms was 9 days, and the median complete recovery time was 40 days after PND. Patients who had a duration of symptoms for a maximum of 12 days were completely healed 30 days after PND.
PND should be the first-choice treatment procedure for acute foot drop due to PNE after bariatric surgery.
减肥手术后体重快速过度减轻，腓骨头周围脂肪垫缺失，可因腓总神经卡压（PNE）导致足下垂症状。已有保守和手术方法用于治疗这种情况，但治疗方式的有效性存在一些争议。
我们旨在调查减肥手术后因PNE导致足下垂的原因和频率，并研究腓总神经减压术（PND）作为PNE手术治疗方法的效果。
单中心大学外科科室。
我们回顾性评估了2607例减肥手术后神经并发症患者。记录患者的年龄、性别、合并疾病、维生素和电解质水平、体重指数和术后超重减轻情况、患侧肢体、症状持续时间和肌肉力量评分（根据医学研究委员会量表）。
共有14例（0.5%）患者因PNE出现足下垂症状。其中9例接受了PND。PND患者术后6个月和12个月的平均超重减轻分别为68.8±13.5和100.9±10.8。足下垂症状在减肥手术后5至11个月出现，所有患者均仅累及单侧下肢。实验室分析显示，所有PND病例均无营养和维生素缺乏或不足的迹象。所有患者的肌肉力量根据医学研究委员会量表均为0级。症状的中位持续时间为9天，PND后中位完全恢复时间为40天。症状持续时间最长为12天的患者在PND后30天完全康复。
PND应作为减肥手术后因PNE导致急性足下垂的首选治疗方法。
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