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Clinical Features of Rhabdomyolysis After Open and Laparoscopic Roux-en-Y Gastric Bypass

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Abstract

Background

Rhabdomyolysis (RML) is caused by muscle injury, this may cause kidneys overload and lead to acute renal failure (ARF). The risk factors for RML in bariatric surgery (BS) are operative time (OT) >4 h and high BMI. The frequency of RML in BS varies from 12.9 to 37.8%. This study has the objective of describing the characteristics associated with RML and ARF in BS.

Methods

We studied retrospectively 114 patients submitted to BS. Criteria for RML were CPK level >950 IU/l (five times the normal value). The variables were BMI, OT, age, intraoperative hydration and diuresis, CPK, creatinine, arterial hypertension, peripheric vascular disease, diabetes, open and laparoscopic techniques—inclusion criteria: patients submitted to gastric bypass; exclusion: renal failure and statins use.

Results

RML incidence was 7%. The factors associated with RML in the bivariate analysis were hepatic steatosis, high BMI, high weight, higher excess weight, and prolonged OT. The risk factor for RML in the multivariate analysis was BMI ≥ 50 kg/m2. When the OT was below 2 h the incidence of RML was zero, but this was not significant in the multivariate analysis. The factors associated with a higher risk of CPK elevation (multivariate analysis) were hypertension and open technique.

Conclusion

BS is safe, with low incidence of RML/ARF. High BMI is associated with a higher risk of RML. Probably a longer OT is associated with a higher risk of RML not statistically demonstrated in this study. The factors associated with a higher risk of CPK elevation were hypertension and open technique.

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Abbreviations

BS:

bariatric surgery

RML:

rhabdomyolysis

ARF:

acute renal failure

OT:

operative time

HSR:

Hospital São Rafael

HC:

Hospital Cidade

CPK:

creatine phosphokinase

ORYGBP:

open Roux-en-Y gastric bypass

LRYGBP:

laparoscopic Roux-en-Y gastric bypass

LAGB:

laparoscopic adjustable gastric banding

SD:

standard deviation

CI:

confidence interval

BMI:

body mass index

OR:

operating room

DS:

duodenal switch

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Acknowledgement

We thank the teachers of the Post-Graduation Course in Medicine & Human Health of the Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil—Dr. Bernardo Galvão, Dr. Armênio Guimarães, Dr. Ana Marice Ladeia, Dr. Ubirajara Barroso, Dr. Marcos Almeida and Dr. Fernanda Grassi. We thank Dr. Liliana Ronzoni Director of the São Rafael Hospital and Dr. André Guanaes director of the Cidade Hospital for supporting our work. We thank Dr. Bernd Genser from BGStats Consulting, Graz, Austria for assistance with statistical analysis.

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Author notes

  1. João E. M. T. M. Ettinger

    Present address: General Surgery Division, Hospital São Rafael, Salvador, Bahia, Brazil

Authors and Affiliations

  1. Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil

    João E. M. T. M. Ettinger, Carlos A. Marcílio de Souza & Paulo V. Santos-Filho

  2. Department of Surgery, EBMSP, Salvador, Bahia, Brazil

    Euler Ázaro, Paulo V. Santos-Filho, Paulo Amaral & Edvaldo Fahel

  3. Bariatric Surgery Unit, Hospital São Rafael & Hospital Cidade, Salvador, Bahia, Brazil

    João E. M. T. M. Ettinger, Euler Ázaro & Carlos A. B. Mello

  4. Gastrointestinal Surgery, Hospital São Rafael, Salvador, Bahia, Brazil

    Juliana Orrico & Rodolfo C. Santana

  5. General Surgery Division, Hospital São Rafael, Salvador, Bahia, Brazil

    Edvaldo Fahel

  6. Nephrology and Intensive Care Division, Department of Ineternal Medicine, Hospital São Rafael, EBMSP, Salvador, Bahia, Brazil

    Paulo Benigno P. Batista

Authors
  1. João E. M. T. M. Ettinger
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  2. Carlos A. Marcílio de Souza
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  3. Euler Ázaro
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Corresponding author

Correspondence to João E. M. T. M. Ettinger.

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Ettinger, J.E.M.T.M., Marcílio de Souza, C.A., Ázaro, E. et al. Clinical Features of Rhabdomyolysis After Open and Laparoscopic Roux-en-Y Gastric Bypass. OBES SURG 18, 635–643 (2008). https://doi.org/10.1007/s11695-007-9257-1

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  • DOI: https://doi.org/10.1007/s11695-007-9257-1

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