Evaluation of Autonomic Nervous System Status with Sympathetic Skin Response in Patients Undergoing Laparoscopic Sleeve Gastrectomy for Morbid Obesity

Abstract

Introduction and Purpose: Obesity is the most common metabolic disease of our time. Bariatric surgery is now accepted as the definitive treatment for morbidly obese patients. The most commonly performed bariatric surgery method is “Laparoscopic Sleeve Gastrectomy (LSG)”. Patients often report various complaints related to the autonomic nervous system after obesity surgery. Sympathetic Skin Response (SSR) is a simple and non-invasive test used for the early diagnosis of dysautonomia in peripheral neuropathy, demonstrating the function of postganglionic unmyelinated sympathetic sudomotor fibers by using changes in skin resistance. This study aims to evaluate the autonomic nervous system status in patients undergoing LSG for morbid obesity using Sympathetic Skin Response (SSR). Method: The study was conducted prospectively with 40 volunteer patients who applied to Harran University Hospital General Surgery Department, had a BMI over 40, and underwent obesity surgery. Patients were neurologically evaluated in the preoperative period. The patients deemed suitable in the evaluation had their SSR recorded with tests conducted by the Neurology Department. The same group of patients had their sympathetic skin responses evaluated and recorded 6 months postoperatively, and statistical analyses were conducted. Findings: The decrease in BMI and SSR latency values before surgery compared to after surgery (p<0.001; p<0.001, respectively) and the increase in SSR amplitude values were found to be statistically significant (p<0.001). Discussion and Conclusion: Our study detected a significant increase in sympathetic skin response post-surgery. Hormonal changes such as the improvement of insulin resistance and the decrease in leptin levels, as well as the stressful nature of the surgical process, might lead to an increase in sympathetic nervous system activity. We believe that performing the low-cost and simple SSR test in patients undergoing obesity surgery could be important for the follow-up of potential neuropathies in the future.