Lesson of the Week: Wernicke's encephalopathy after vertical banded gastroplasty for morbid obesity

Recognised predisposing conditions include alcoholism, gastric carcinoma, pyloric obstruction, hyperemesis gravidarum, and prolonged intravenous feeding. 1 We have recently encountered two cases of Wernicke's encephalopathy after vertical banded gastroplasty for morbid obesity. Discussion Gastric partitioning surgery can lead to a state of starvation: "starvation in the midst of plenty" 3 that can lead to serious protein-calorie and vitamin deficiency that may in turn cause serious neurological, as well as other, sequelae. Since increasing numbers of people are undergoing surgery for morbid obesity-typically, vertical banded gastroplasty-we are likely to see significantly more neurological complications, such as Wernicke's encephalopathy, which occurs as a result of thiamine deficiency and can be prevented by supplementation.