As the Summer Season Approaches, you might be on the look- out for cases involving a serious condition called Wernicke’s encephalopathy.
Wernicke’s encephalopathy [“WE”] is a serious neurological condition traditionally associated with alcoholism. However, Bariatric Surgery (particularly Sleeve Gastrectomy) has now become a major risk factor for WE in non-alcoholics.
Sleeve Gastrectomy is becoming the most popular type of Bariatric Surgery today as it promises significant weight loss in a very short period of time. The surgery involves removing approximately 80% of the stomach, resulting in a drastic loss in nutrient absorption. This loss places the patient at risk of several vitamin deficiencies, particularly Vitamin B1, also known as Thiamine. Without proper supplementation and post-op follow-up, thiamine deficiency can quickly result in Wernicke’s Encephalopathy [“WE”], a potentially devastating condition that can progress to permanent severe brain damage, coma and death.
Signs and symptoms of WE include nausea, vomiting, confusion, vision disturbances and loss of balance. Unfortunately, these same symptoms are also indicative of any number of other conditions, and thiamine deficiency may be overlooked as a possible cause. Failure to diagnose and treat this deficiency can result in irreversible brain damage for the patient and medical liability for providers.
Progression from thiamine deficiency to WE may take place anywhere from 6 to 15 weeks following surgery. Keeping in mind that many people make weight loss their top New Year’s Resolution, they typically undergo Bariatric Surgery in the spring. Accordingly, we are approaching the season where an increase in cases might be on the rise.
Another factor to consider is the increasing popularity of “medical tourism” where patients can travel to Mexico for sleeve gastrectomies as cheap as $3,995.00. Follow-up is minimal to non-existent, meaning risk of complications such as WE is increased. Since Texas borders Mexico, it also stands to reason that Texas will see a disproportionately larger number of these patients when post-op complications occur.
The American Society for Metabolic and Bariatric Surgeons’ [“ASMBS”] 2016 revised guidelines recommend that all weight loss surgery patients take above the recommended daily allowance of Thiamine to prevent thiamine deficiency, noting,
“Prevalence of micronutrient deficiencies is increasing while monitoring of patients at follow-up is decreasing. …”
The ASMBS has also stated,
“Based on the unique characteristics of the bariatric patient, the potential for major early and late complications after bariatric procedures, the specific follow-up requirements for different bariatric procedures, and the nature of treating the chronic disease of obesity, extensive travel to undergo bariatric surgery should be discouraged unless appropriate follow-up and continuity of care are arranged and transfer of medical information is adequate.”
Other relevant news about WE:
- 2014 – Law Firm Harry S. Cohen & Assoc. (Pittsburg, PA) won settlement for undisclosed “substantial amount” in Becky Fulton WE case;
- 2017 – TMLT [Texas Medical Liability Trust – major provider of medical liability insurance] issued “Risk Alert,” noting, “TMLT claims and risk management departments have seen an alarming increase in the number of claims filed related to Wernicke’s encephalopathy following bariatric surgery.“
- 2017 – Tom Rhodes Law Firm won $14 million verdict in WE malpractice case.
References:
- Bariatric Surgery Procedures. Sleeve Gastrectomy. American Society for Metabolic and Bariatric Surgery. Retrieved at: https://asmbs.org/patients/bariatric-surgery-procedures#sleeve
- The Neurological Complications of Nutritional Deficiency following Bariatric Surgery. Review Article. J Obesity. Vol. 2012:1-8. Retrieved at: https://www.hindawi.com/journals/jobe/2012/608534/
- Medical Tourism. American Society for Metabolic and Bariatric Surgery. Retrieved at: https://asmbs.org/patients/medical-tourism
- Bariatric Surgery in Mexico $3,995. On-line Advertisement. Medical Tourism Corporation. Retrieved at: https://www.medicaltourismco.com/texas-bariatric-surgery-mexico/?gclid=CjwKCAjw4sLVBRAlEiwASblR-1Owf0vK6ucHd1QJGIyBdo5sarpCUTjpZOk4ynDEPyzYg_9CToaXjBoC9OoQAvD_BwE
- Oklahoma Woman Nearly Dies After Weight Loss Surgery in Mexico. NewsOn6.com. Jan 11, 2018. Retrieved at: http://www.newson6.com/story/37250180/ok-woman-nearly-dies-after-weight-loss-surgery-in-mexico
- Mexican Weight-loss Surgeries Prompt Call for Health Warning. Canadian Broadcasting Corp. Retrieved at: http://www.cbc.ca/news/canada/edmonton/mexican-weight-loss-surgeries-prompt-call-for-health-warning-1.2560052
- Failure to Diagnose Thiamine Deficiency/Wernicke’s Encephalopathy. The Fulton Case. Harry S. Cohen & Assoc., P.C. Retrieved at: https://medmal1.com/results/casefile/failure-to-diagnose-thiamine-deficiency-wernickes-encephalopathy
- Risk Alert: Wernicke’s Encephalopathy after Bariatric Surgery. TMLT/Resource Hub. 2017. Retrieved at: https://hub.tmlt.org/general-marketing-materials/risk-alert-wernickes-encephalopathy
- Tom Rhodes Law Firm Secures $14 Million Verdict in Bexar County Medical Malpractice Case. Tom Rhodes Law Firm P.C. Blog Oct 2017. Retrieved at: https://www.tomrhodeslawfirm.com/blog/2017/october/tom-rhodes-law-firm-secures-14-million-verdict-i/#~s435h9
