Rhabdomyolysis after biliopancreatic diversion with duodenal switch

[Value and Role of Obesity and Metabolic Surgery in the Study of Human Medicine, Academic Teaching and Advanced Training]

In teaching, obesity and metabolic surgery play only a limited role. However, due to the rapidly increasing number of surgical interventions, communication of knowledge in the study of human medicine as well as in gastroenterological and surgical residency (general and abdominal surgery) is required.Narrative review. · Currently, lectures on obesity and metabolic surgery do not belong to the current surgical curriculum of human medicine at all University Medical Schools, which needs to be absolutely established step by step - based on their topicality and importance in the clinical spectrum of clinical care.. · This rapidly developing special area of abdominal surgery is characterized by specific and diverse interdisciplinarity.. · Multimorbidity, changes in resorption mechanisms but also psychological changes have a substantial impact on the indication and patient outcome.. · The increase in endoscopic, surgical and also robotic interventions and surgical methods in this special field requires a broad knowledge of all surgical disciplines in intervention preparation, perioperative and follow-up management of obesity-associated basic diagnosis. This objective is important even in the study of human medicine and further advanced training.. The inclusion of such complex contents on obesity and metabolic surgery into surgical teaching and into residency of general and abdominal surgery is essential to be future-oriented and prepared for the development of the discipline.

Prevalence of Rhabdomyolysis Following Bariatric Surgery and its Associated Risk Factors: a Meta-Analysis

PURPOSE

This study aimed to evaluate the prevalence of rhabdomyolysis (RML) following bariatric surgery and potential associated factors.

MATERIALS AND METHODS

We systematically searched PubMed, Embase, and CENTRAL for relevant trials from database inception through August 2022. Articles were eligible for inclusion if they reported the prevalence of RML after bariatric surgery and provided at least one of the following outcome indicators: preoperative mean BMI/mean operative time for the included population.

RESULTS

Sixteen studies with a total of 1540 patients were analyzed. The mean preoperative age distribution of the included patients was centered between 32.9 and 47.0 years, and the mean preoperative BMI ranged from 42.3 to 60.0 kg/m². The operative time varied between 126.7 and 403.3 min. The overall pooled crude prevalence of post-bariatric surgery RML was 19.4%. Subgroup analyses showed the pooled prevalence of RML was 8.1% for operative duration > 120 and ≤ 180 min, 32.8% for > 180 and ≤ 240 min, and 47.4% for > 240 min. Meta-regression revealed that operation time was an independent risk factor for developing RML. Besides, BMI > 50 kg/m² and open Roux-en-Y gastric bypass (RYGB) indicated a higher risk of RML.

CONCLUSION

Post-bariatric surgery RML prevalence occurred more frequently with the extension of the operation time. For bariatric subjects with surgery time > 180 min, open RYGB, or BMI > 50 kg/m², CKP could be routinely measured early to verify the presence of RML and to actively prevent its fatal complications.

Management of biliary stones in bariatric surgery

Morbidly obese and post-bariatric surgery patients are at increased risk for biliary stones formation. The complications related to biliary stones may impose complexity on their management. This study aimed to review the management of biliary conditions in obese and bariatric patients. In this study, a narrative review was performed of the medical, surgical, and endoscopic procedures for the management of biliary stones and their related complications. Knowing the main prophylactic and therapeutic interventions options is essential for clinicians to properly manage the biliary stones in patients candidates or submitted to bariatric surgery.

Joint consensus on abdominal robotic surgery and anesthesia from a task force of the SIAARTI and SIC

Minimally invasive surgical procedures have revolutionized the world of surgery in the past decades. While laparoscopy, the first minimally invasive surgical technique to be developed, is widely used and has been addressed by several guidelines and recommendations, the implementation of robotic-assisted surgery is still hindered by the lack of consensus documents that support healthcare professionals in the management of this novel surgical procedure. Here we summarize the available evidence and provide expert opinion aimed at improving the implementation and resolution of issues derived from robotic abdominal surgery procedures. A joint task force of Italian surgeons, anesthesiologists and clinical epidemiologists reviewed the available evidence on robotic abdominal surgery. Recommendations were graded according to the strength of evidence. Statements and recommendations are provided for general issues regarding robotic abdominal surgery, operating theatre organization, preoperative patient assessment and preparation, intraoperative management, and postoperative procedures and discharge. The consensus document provides evidence-based recommendations and expert statements aimed at improving the implementation and management of robotic abdominal surgery.

Rhabdomyolysis in bariatric surgery: a systematic review

BACKGROUND

Rhabdomyolysis (RML) is a rare complication of bariatric surgery. A systematic review was performed to identify risk factors and patient outcomes in morbidly obese patients undergoing bariatric surgery who develop RML.

METHODS

A comprehensive search was performed between January 1990 and March 2012 using relevant MeSH terms. Studies were chosen based on predefined inclusion criteria. RML was defined as a creatine kinase of more than 1,000 IU/L. The parameters assessed included patient characteristics of the RML population, type of bariatric surgery performed, operating time, complications, presentation and diagnosis of RML.

RESULTS

Twenty-two studies were analysed which included 11 case reports, two case series, six prospective and three retrospective comparative studies. Overall 145 patients with RML were reported following bariatric surgery. Acute renal failure was found in 20 patients (14 %) and was significantly more likely to occur in patients with postoperative muscle pain (p < 0.05). The mortality rate after renal failure was 25 % (n = 5). In the comparative studies, 87 RML patients were compared with 325 non-RML patients. The RML patients were more likely to be male, had a greater mean body mass index (BMI) (52 vs 48 kg/m(2), p < 0.01) and underwent a longer operation (255 vs 207 min, p < 0.01) compared to non-RML patients.

CONCLUSIONS

Risk factors of developing RML following bariatric surgery include male gender, elevated BMI and prolonged operating time. Patients with a biochemical diagnosis of RML and postoperative myalgia after bariatric surgery are at increased risk of developing acute renal failure and mortality. These patients must be identified and treated promptly.

Rhabdomyolysis: An unusual complication following endoscopic component separation hernia repair

Separation of components technique for incisional hernia repair is increasingly utilized as a strategy for hernia repair in both the obese and those with loss of abdominal domain. Endoscopic component separation technique [ECST] is increasingly performed to minimize wound complications associated with the open procedure. We present a case of a patient who developed acute renal failure related to rhabdomyolysis following ECST. A 62-year-old morbidly obese female with BMI of 46 underwent ECST hernia repair for a large midline hernia with loss of domain. Postoperatively, she was found to be oliguric with a dark brown colored urine, elevated serum creatinine and blood urea nitrogen, and increased urine myoglobin levels. She recovered with aggressive hydration and urine alkalinization. We present this unique complication and review the literature.

Bariatric surgery and renal function

Obesity causes a significant healthcare burden and has been shown to be an important risk factor in the development of cardiovascular disease, type 2 diabetes, and increasingly chronic kidney disease. Bariatric surgery is the most effective treatment for obesity and has been shown to drastically improve both blood pressure and diabetic control. However, the interaction of bariatric surgery and renal function is less clear. This review focuses on the effect of bariatric surgery on renal function both in the acute situation, with respect to acute kidney injury, and also on changes in renal function parameters post-bariatric surgery weight loss. The interaction of obesity, bariatric surgery, and nephrolithiasis as a precipitant of acute kidney injury will also be considered. The role of bariatric surgery in pre- and post-renal transplant recipients is discussed as well as possible mechanisms underlying the improvement in renal function.

Medical management of postsurgical complications: the bariatric surgeon's perspective

Bariatric surgery remains the only effective method to initiate and sustain massive weight loss in morbidly obese patients. Along with the advent of minimal access surgery, its popularity has not only resulted in an exponential increase in number of cases but also a subsequent increase in number of complications. Although most postsurgical bariatric complications are managed surgically, it is imperative that all physicians be aware of the unique potential complications to effectively communicate and optimize the medical management in this emergent set of patients.

Rhabdomyolysis and acute renal failure in severely burned patients

Rhabdomyolysis (RML) is a precarious complication in severely burned patients and the principal treatment goal is prevention of acute renal failure (ARF). This 10-year retrospective study analyses the causes for RML in severely burned patients and evaluates treatment algorithms. Eight of 714 patients (1%) were diagnosed with RML. Percentage TBSA burn was 25 ± 13%. The mean abbreviated burn severity index score (ABSI) was 9 ± 2. ARF was found in 75% (6/8) of the patients. Serum myoglobin (MB) was reduced by 41 ± 16% after 24-h treatment by solitary volume repletion (VR) and by 44 ± 20% through VR+continuous veno-venous hemodiafiltration (CVVHDF). Mortality was 50% (4/8). Peak mean CPK-levels were more than two and MB-levels more than four times higher in non-survivors than in survivors. Burns associated with RML result in poor survival. VR and CVVHDF are effective measures in treating RML. CVVHDF is effective in removing MB when using high flux filter membranes. Early CVVHDF (within 24h of diagnosis) with high-cut off membranes could reduce the risk of ARF and mortality.

Bariatric surgery: Rhabdomyolysis after open Roux-en-Y gastric bypass: a prospective study

BACKGROUND

Rhabdomyolysis (RML) is a recently recognized complication of bariatric surgery (BS). The aim of this prospective study was to determine frequency, risk factors, and clinical relevance of RML in morbidly obese patients treated with open Roux-en-Y gastric bypass (RYGBP).

METHODS

A total of 23 consecutive patients with morbid obesity undergoing primary open RYGBP were included prospectively in the present study. The following parameters were recorded: age, gender, BMI (kg/m(2)), comorbidities (presence of known hypertension and diabetes), duration of surgery, levels of serum creatine phosphokinase (CPK) measured before surgery and daily after until the values were clearly tending towards normal, and the presence of neuromuscular symptoms in the early post-operative period. RML was defined as post-operative CPK >1000 IU/l (5 times the normal value). Patients were divided into two groups according to the presence or absence of RML.

RESULTS

The study sample consists of 16 females (69.6%) and 7 males (29.4%). RML was diagnosed in 7 (30.4%) patients with CPK levels greater than 5000 IU/l in 3 patients (42.9%). BMI was identified as an independent risk factor for RML (P = 0.031). The best cut-off value of BMI as a predictor of RML was 55.88 kg/m(2) giving sensitivity of 100% and specificity of 80.7%. Other variables (age, sex, comorbidities, and duration of surgery) did not have a significant predictive effect on the rate of RML.

CONCLUSION

After open bariatric surgery with RYGBP, the risk of RML increases in obese patients specially when BMI >56 kg/m(2). In such patients, CPK, which is an inexpensive easily done test, should be performed routinely to guarantee early diagnosis and consequently preventive treatment of RML complications.

Status of bariatric surgery in Germany--results of the nationwide survey on bariatric surgery 2005-2007

BACKGROUND

Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Ottovon-Guericke University of Magdeburg (Germany) since January 1, 2005.

METHODS

In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an internet online data registry. Perioperative characteristics such as the spectrum of diagnostic measurements, type of surgical procedures, and short- and long-term outcomes were investigated.

RESULTS

During the study period 3,123 surgical procedures were performed. In 2005 and 2006, gastric banding (GB) was the operation performed most frequently, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean BMI ranged from 48.5 kg/m2 in 2005 to 48.0 kg/m2 in 2007. Follow-up data after 12 months were available for 63.8% of the patients operated in 2005 and 2006. The mortality was 0.1% (30 days) and 0.16% (overall).

CONCLUSION

As indicated by the worldwide trend, there is an ongoing change from GB to sleeve gastrectomy (SG) and malabsorptive procedures. The BMI of German bariatric surgical patients is substantially higher than that of patients from most other countries. There were no differences in overall outcomes during follow-up as compared to published studies.

Rhabdomyolysis after bariatric surgery by Roux-en-Y gastric bypass: a prospective study

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.

CONCLUSION

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.

A nationwide survey on bariatric surgery in Germany--results 2005-2007

BACKGROUND

Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined since January 1st, 2005 with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany).

METHODS

In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an Internet online data registry. In particular, perioperative characteristics, such as the spectrum of diagnostic measurements, type of surgical procedures, and short- and long-term outcomes, were investigated.

RESULTS

During the study period, 629 surgical procedures were performed at 21 hospitals in 2005, 828 procedures at 32 hospitals in 2006, and 1,666 procedures at 35 hospitals in 2007. In 2005 and 2006, gastric banding was the most frequently performed operation, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean body mass index (BMI) was 48.5 kg/m(2) in 2005, 48.4 kg/m(2) in 2006, and 48.0 kg/m(2) in 2007. Follow-up data after 12 months were available for 63.8% of the patients in 2005 and 2006; these data showed greater reduction of BMI after malabsorptive rather than restrictive bariatric procedures. The mortality was 0.1% (30 days) and 0.16% (overall).

CONCLUSION

As indicated by the worldwide trend, there is an ongoing change from restrictive bariatric procedures to malabsorptive procedures and sleeve gastrectomy. Although the BMIs of German patients undergoing bariatric surgery appear to be substantially higher than those of patients from most other countries, there were no differences in intraoperative and short-term complications or in overall outcomes during follow-up when compared with published studies.

Rhabdomyolysis: diagnosis and treatment in bariatric surgery

BACKGROUND

Rhabdomyolysis (RML) and subsequent acute renal failure can be serious problems following bariatric operations. Early diagnosis and treatment are important to avoid the complications of RML.

METHODS

This review was achieved by searching the key words: Rhabdomyolysis, diagnosis, treatment and bariatric surgery. We included prospective, retrospective, case reports and review articles.

RESULTS

RML diagnosis can be done by: signs and symptoms, physical evaluation, laboratory findings and imaging examinations. Muscle weakness, myalgia, decubitus ulcer, proteinuria and myoglobinuria are the more mentioned findings. Elevation of CPK levels is the most sensitive diagnostic evidence of RML. Treatment is geared toward preserving renal function by avoiding dehydration, hypovolemia, tubular obstruction, aciduria, and free radical release. Early recognition allows the administration of fluids, bicarbonate, and mannitol.

CONCLUSION

Prophylactic measures and early diagnosis and treatment of rhabdomyolysis in bariatric surgery are imperative to prevent the potential fatal complications of this condition.

Wounds in Surgical Patients Who Are Obese

The number of surgical patients who are obese in the United States is rising, a trend that's likely to continue. Such patients are at higher risk than nonobese patients are for surgical site infections and other complications such as dehiscence, pressure ulcers, deep tissue injury, and rhabdomyolysis. This article details the factors that can contribute to such complications, including a high number of comorbidities, and offers practical suggestions for preventing them. Nurses should understand that special equipment, precautions, and protocols may be needed at every stage of care, and that obese patients aren't anomalies but rather a part of a growing population with particular needs.