Compartment syndrome after gynecologic laparoscopy: systematic review of the literature and establishment of normal values for postoperative serum creatine kinase and myoglobin levels.

Abstract

To evaluate published evidence in the literature on compartment syndrome (CS) in association with gynecologic surgery and to establish postoperative normal values for serum creatine kinase (CK) and myoglobin. The present study consists of a case report of a patient with CS, a systematic review including 37 studies and 86 patients with CS, and a retrospective cohort study of 300 patients undergoing various types of laparoscopy for benign or malignant diseases in order to establish postoperative normal values. We report on a patient with early-stage ovarian cancer, who developed CS after laparoscopic surgery with massively elevated serum CK and myoglobin levels, i.e., 1109U/L and 18151µg/L, respectively. In our systematic review, median serum CK and myoglobin levels among women with CS were 19,223 (177-27,412)U/L and 1248 (285-1360)µg/L, respectively. In our cohort study, the median postoperative serum CK and myoglobin levels were 68 (14-1576)U/L and 45 (14-1040)µg/L, respectively. The 95th and 99th percentile of serum CK and myoglobin levels were 158 and 391.5U/L, and 152.3 and 298.9µg/L, respectively. Markedly elevated postoperative serum levels of CK and myoglobin levels might raise the suspicion for CS and could therefore aid in the rapid diagnosis of CS.