title: Rhabdomyolysis after bariatric surgery by Roux-en-Y gastric bypass: a prospective study.
abstract: BACKGROUND
  Obesity is a worldwide epidemic associated to comorbidities and increased mortality. Because it is chronic and recurrent and has little response to clinical measures, surgical treatment (bariatric surgery) is a therapeutic option frequently used. Different surgical complications have been associated with this type of procedure, but there is little knowledge about neuromuscular complications. Among the latter, rhabdomyolysis (RML), described a few years ago, has not been well characterized to date.
  
  
  METHODS
  We have studied 22 consecutive patients who underwent surgical treatment with open Roux-en-Y gastric bypass (RYGBP) for morbid obesity in a university hospital. A database was created including the following information of each patient: gender, age, body mass index (BMI), comorbidities, surgical time, pre- and postoperative creatine phosphokinase (CPK) dosages, and neuromuscular symptoms after surgery. The main outcome measure was the frequency of RML using CPK dosage after 24 h of surgery. RML was diagnosed as an increase of more than five times the superior limit of normal range of CPK.
  
  
  RESULTS
  Fourteen women and eight men were evaluated, with median age of 39.9+/-11.2 years, median BMI of 52.4+/-8.0 kg/m2 and mean surgical time of 253.2+/-51.9 min. The mean value of postoperative CPK was 7,467.7+/-12,177.1 IU/L, being greater than 5,000 IU/L in 40.9% of the patients. RML was diagnosed in 17 (77.3%) patients. No patient had renal failure caused by RML, but there was one death (4.5%) related to abdominal infectious complications. Clinical neuromuscular symptoms occurred in 45% of patients, and muscular pain was the most common one, especially in gluteus region. Comparative analyzes between patients without and with RML diagnosis showed that longer surgical time (p=0.005), and occurrence of neuromuscular symptoms (p=0.04) were more common in the latter.
  
  
  CONCLUSIONS
  The results of this study are similar to few other investigations and confirm that RML in open bariatric surgery with RYGBP (Capella) is a common complication. A longer surgical time can be involved in RML pathogenesis, and muscular pain is suggestive of RML occurrence.
authors.affiliation: Neurology Service, Internal Medicine Department, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Leonardo Dornas
authors.initials: LD
authors.lastname: de Oliveira
authors.forename: Marco Túlio C
authors.initials: MT
authors.lastname: Diniz
authors.forename: Maria
authors.initials: M
authors.lastname: de Fátima H S Diniz
authors.forename: Alexandre L
authors.initials: AL
authors.lastname: Savassi-Rocha
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Camargos
authors.forename: Francisco
authors.initials: F
authors.lastname: Cardoso
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D012206:Rhabdomyolysis / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality
chemical_list: D003402:Creatine Kinase