Abstract
Background: Rhabdomyolysis (RML) indicates a skeletal muscle necrosis which results in an emission of intracellular contents from myocytes into the circulatory system. It has been recognized to be a complication of bariatric surgery. A high BMI and a prolonged operative time are the main risk factors associated to the development of RML. The aim of this study is to define the incidence and the main features of RML in a cohort of obese patients undergoing bariatric surgery. Materials and Methods: a retrospective observational analysis was carried out on 100 patients undergone bariatric surgery. The bariatric operations were open or laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG); they were performed at the university hospital Nuovo S. Chiara in 2011. Results: 6 of 100 patients enrolled developed RML. Three of these also showed acute kidney injury due to RML (50%). A significant correlation between post-operative increased creatine phosphokinase (CPK) levels and BMI was found (r=0.369; r2=0,137; p=0.005) as well as a significant correlation between the increased levels of creatine phosphokinase, myoglobin and operative time (increased operative time - highest CPK: r=0.550; r2=0.302; p<0.0001; increased operative time - highest myoglobin: r=0.553; r2=0.305; p<0.0001). Moreover, hypertension and prolonged operative time were found to be variables associated with RML in bivariate analysis. Conclusions: The incidence of RML following bariatric surgery was 6%. Since rhabdomyolysis is the most important complication of bariatric surgery, appropriate precautions should be taken during surgery. Post-operative monitoring of CPK and myoglobin levels is essential for an early diagnosis of RML.
Highlights
Obesity is an epidemic world health problem which affects over 200 million of men and nearly 300 million of women, in both developed and developing countries [1]
Since rhabdomyolysis is the most important complication of bariatric surgery, appropriate precautions should be taken during surgery
RML ranges from an asymptomatic state with increased creatine phosphokinase (CPK), lactate dehydrogenase (LDH) and myoglobin levels to a potentially life threatening condition associated with acute renal failure (ARF), electrolyte imbalance, disseminated intravascular coagulation (DIC) and cardiac arrest [4]
Summary
Obesity is an epidemic world health problem which affects over 200 million of men and nearly 300 million of women, in both developed and developing countries [1]. Rhabdomyolysis (RML) is a potentially life threatening disorder characterized by the necrosis of skeletal muscle resulting in the release of intra-cellular muscle components into the circulation and interstitial space; it has been recognized to be a complication of bariatric surgery. RML has several causes: muscle trauma is the most common, instead the use of drugs (statins, for instance), prolonged immobilization, excessive muscular activity, electrolyte imbalances, infection, toxins, seizure and genetic disorders are less common causes [5]. Rhabdomyolysis (RML) indicates a skeletal muscle necrosis which results in an emission of intracellular contents from myocytes into the circulatory system. The aim of this study is to define the incidence and the main features of RML in a cohort of obese patients undergoing bariatric surgery
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