Sciatic neuropathy after body contouring surgery in massive weight loss patients

doi:10.1016/j.bjps.2009.07.022

Journal of Plastic, Reconstructive & Aesthetic Surgery

Volume 63, Issue 5, May 2010, Pages e454-e457

https://doi.org/10.1016/j.bjps.2009.07.022 Get rights and content

Summary

To date, obesity affects a substantial population in industrialised countries. Due to the increased awareness of obesity-related morbidity, efficient dietary regimens and the recent successes with bariatric surgery, there is now a high demand for body contouring surgery to correct skin abundancies after massive weight loss. The known risks for this type of surgery are mainly wound-healing complications, and, more rarely, thromboembolic or respiratory complications.

We present two female patients (23 and 39 years of age) who, in spite of standard positioning and precautions, developed sciatic neuropathy after combined body contouring procedures, including abdominoplasty and inner thigh lift. Complete functional loss of the sciatic nerve was found by clinical and electroneurographic examination on the left side in patient one and bilaterally in patient two. Full nerve conductance recovery was obtained after 6 months in both patients.

Although the occurrence of spontaneous neuropathies after heavy weight loss is well documented, this is the first report describing the appearance of such a phenomenon following body contouring surgery. One theoretical explanation may be the compression of the nerve during the semirecumbent positioning combined with hip flexion and abduction, which was required for abdominal closure and simultaneous access to the inner thighs. We advise to avoid this positioning and to include the risk of sciatic neuropathy in the routine preoperative information of patients scheduled for body contouring surgery after heavy weight loss.

Section snippets

Case one

A twenty-three-year-old female had undergone a dietary weight loss from 105 to 72 kg within 24 months, which corresponds to a BMI reduction from 39 to 27 kg m⁻² (Figure 1). Her medical history was blank in particular for neurological diseases. After her weight has been kept stable for more than 12 months, a circumferential body lift and bilateral inner thigh lift was performed using standardised techniques.2, 3, 4, 5 Strips of skin of maximally eight cm were resected on the back, 30 cm in the lower

Case two

After laparoscopic gastric banding eight years ago, this 39 year old female had reduced her weight from 110 to 68 kg (BMI 40 to 24 kg m⁻²), which she has kept stable for several years thereafter. Her medical history was free of neurologic diseases.

A one-stage body contouring procedure was performed including bilateral mastopexy/breast augmentation (280 cc anatomical textured implants), abdominoplasty and bilateral inner thigh lift by using standardised techniques.2, 3, 4, 5 The maximal widths of

Discussion

To the best of our knowledge, this is the first scientific report documenting sciatic neuropathy following body contouring surgery after heavy weight loss.

The clinical and electroneurographic findings suggested a lesion of the sciatic nerve proximal to the branch to the biceps femoris muscle, which was compatible with compression neuropathy.

Unlike other nerves, such as the ulnar, median or peroneal nerve, the sciatic nerve falls victim to intraoperative positioning very rarely.⁷ Anecdotical

Conflict of interest

None.

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Citation Excerpt :
In this regard, both brachial plexus and ulnar nerve have been commonly reported, especially in lengthy procedures, but there have also been reports of sciatic nerve damage because of gluteal compartment syndrome [26,27]. Interestingly, there have also been reports of sciatic neuropathy due to body contouring surgery after massive weight loss [28]. Moreover, Meralgia parestethica has also been related to both morbid obesity and immediate post-BS period [29].
Bariatric surgery is gaining popularity as the treatment of choice of morbid obesity since this condition is constantly increasing over the last decades. Several complications have emerged as the number of surgeries and follow-up data increase. No systematic review of the neurosurgery-related potential complications has been performed to date. Objective of this work is to fill this gap. We reviewed the literature for bariatric surgery-related complications involving the neurosurgical practice. Moreover, we present explicative cases dealing with peri- and post-operative therapeutic precautions. Three pathological mechanisms emerged. The first is related to intracranial pressure alterations and may imply either intracranial hypertension or hypotension syndromes in the operative or post-operative periods. The second is the deficiency of macro- and micro-nutrients which are potential risk factors for neuro- or myelo-encephalopathies, fetal malformations and spine disorders. The third is a dysregulation of both autonomic and endocrine / pituitary control. Neurosurgeons must be aware of the several, multifactorial neurosurgery-related complications of bariatric surgery as their prevalence is likely to be higher in the next few years.
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Case ReportSciatic neuropathy after body contouring surgery in massive weight loss patients

Summary

Section snippets

Case one

Case two

Discussion

Conflict of interest

Obstet Gynecol

Int J Obstet Anesth

Epidemiology of overweight in Switzerland: results of the Swiss National Health Survey 1992–93

Schweiz Med Wochenschr

Body contouring of the trunk/thigh aesthetic unit

Plast Surg Nurs

Remodeling bodylift with high lateral tension

Aesthet Plast Surg

Is it safe to combine abdominoplasty with other dermolipectomy procedures to correct skin excess after weight loss?

Ann Plast Surg

Case Report
Sciatic neuropathy after body contouring surgery in massive weight loss patients