Obesity Surgery

, Volume 19, Issue 8, pp 1102–1107 | Cite as

Rhabdomyolysis After Bariatric Surgery by Roux-en-Y Gastric Bypass: A Prospective Study

  • Leonardo Dornas de Oliveira
  • Marco Túlio C. Diniz
  • Maria de Fátima H. S. Diniz
  • Alexandre L. Savassi-Rocha
  • Sarah T. Camargos
  • Francisco CardosoEmail author
Research Article



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.


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.


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.


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.


Rhabdomyolysis Morbid obesity Bariatric surgery Gastric bypass Complications Creatine phosphokinase (CPK) RYGBP Capella 


  1. 1.
    World Health Organization [WHO]. BMI classification. Avaliable at = intro_3.html. Accessed on 14 Dec 2006.
  2. 2.
    Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg 2003;13:329–30.CrossRefGoogle Scholar
  3. 3.
    Simopoulos A, Van Italie T. Body weight, health and longevity. Ann Intern Med 1984;100:285–95.CrossRefGoogle Scholar
  4. 4.
    Goldstein DJ. Beneficial health effects of modest weight lost. Int J Obes 1991;16:397–415.Google Scholar
  5. 5.
    Monteforte MJ, Turkelson CM. Bariatric surgery for morbid obesity. Obes Surg 2000;10:391–401.CrossRefGoogle Scholar
  6. 6.
    Steinbrook R. Surgery for severe obesity. N Engl J Med 2004;350:1075–9.CrossRefGoogle Scholar
  7. 7.
    Mottim CC. Associação Brasileira para Estudo da Obesidade e da Síndrome Metabólica. Avaliable at Accessed on 14 Dec 2006.
  8. 8.
    Abarbanel JM, Berginer VM, Osimani A. Neurologic complications after gastric restriction surgery for morbid obesity. Neurology 1987;37:196–200.CrossRefGoogle Scholar
  9. 9.
    Koffman BM, Greenfield LJ, Ali II. Neurologic complications after surgery for obesity. Muscle Nerve 2006;33:166–76.CrossRefGoogle Scholar
  10. 10.
    Juhasz-Pocsine, Rudnicki SA, Archer RL. Neurological complications of gastric bypass surgery for morbid obesity. Neurology 2008;68:1843–50.CrossRefGoogle Scholar
  11. 11.
    Wiltshire J, Custer T. Lumbar muscle rhabdomyolysis as a cause of acute renal failure after Roux-en-Y gastric bypass. Obes Surg 2003;13:306–13.CrossRefGoogle Scholar
  12. 12.
    Lachiewicz PF, Latimer HA. Rhabdomyolysis following total hip arthroplasty. J Bone Jt Surg 1991;73:576–9.CrossRefGoogle Scholar
  13. 13.
    Cone AM, Schneider M. Massive rhabdomyolysis following cardiopulmonary bypass. Anaesth Intensive Care 1995;23:721–4.PubMedGoogle Scholar
  14. 14.
    Bruce RG, Kim FH, McRoberts W. Rhabdomyolysis and acute renal failure following radical perineal prostatectomy. Urology 1996;47:427–30.CrossRefGoogle Scholar
  15. 15.
    Biswas S, Gnanasekaran I, Ivatury RR. Exaggerated lithotomy position-related rhadomyolysis. Am Surg 1997;63:361–4.PubMedGoogle Scholar
  16. 16.
    Prabhu M, Samra S. An unusual cause of rhabdomyolysis following surgery in prone position. J Neurosurg Anesthesiol 2000;12:359–63.CrossRefGoogle Scholar
  17. 17.
    Iseri C, Senkul T, Reddy PK. Major urologic surgery and rhabdomyolysis in two obese patients. Int J Urol 2003;10:558–60.CrossRefGoogle Scholar
  18. 18.
    Bostanjian D, Anthone GJ, Hamoui N. Rhabdomyolysis of gluteal muscles leading to renal failure: a potentially fatal complication of surgery in the morbidly obese. Obes Surg 2003;13:302–5.CrossRefGoogle Scholar
  19. 19.
    Collier B, Goreja A, Duke BE. Postoperative rhabdomyolysis with bariatric surgery. Obes Surg 2003;13:941–3.CrossRefGoogle Scholar
  20. 20.
    Torres-Villalobos G, Kimura E, Mosqueda JL. Pressure-induced rhabdomyolysis after bariatric surgery. Obes Surg 2003;13:297–301.CrossRefGoogle Scholar
  21. 21.
    Delfino V, Miguita RJ, Mocelin AJ. IRA por rabdomiólise após cirurgia bariátrica: relato de caso. J Bras Nefrol 2004;26:145–8.Google Scholar
  22. 22.
    Khurana RN, Baudendistel TE, Morgan EF. Postoperative rhabdomyolysis following laparoscopic gastric bypass in the morbidly obese. Arch Surg 2004;139:73–6.CrossRefGoogle Scholar
  23. 23.
    Fillis D, Daskalakis M, Askoxylakis I. Rhabdomyolysis following laparoscopic gastric bypass. Obes Surg 2005;15:1496–500.CrossRefGoogle Scholar
  24. 24.
    Pasnik K, Krupa J, Stanowski E. Successful treatment of gastric fistula following rhabdomyolysis after vertical banded gastroplasty. Obes Surg 2005;15:428–30.CrossRefGoogle Scholar
  25. 25.
    Stroh C, Hohmann U, Remmler K. Rhabdomyolysis after biliopancreatic diversion with duodenal switch. Obes Surg 2005;15:1347–51.CrossRefGoogle Scholar
  26. 26.
    Uranga RJ, Sanches UA, Dias PJ. Neuropathy of common sciatic nerve secondary to compartment syndrome as complication after bariatric surgery. Neurologia 2005;20:94–7.Google Scholar
  27. 27.
    Abrão MA, Ferreira RG, Germano Filho PA, et al. Rabdomiólise em paciente obeso mórbido submetido à gastroplastia redutora e durante revascularização de membro superior em pacientes pediátrico. Relato de casos. Rev Bras Anestesiol 1996;56:63–71.Google Scholar
  28. 28.
    Benevides ML, Nochi JRJ. Rabdomiólise por síndrome compartimental glútea após cirurgia bariátrica. Relato de caso. Rev Bras Anestesiol 2006;56:408–12.CrossRefGoogle Scholar
  29. 29.
    Mognol P, Vignes S, Chosidow D. Rhabdomyolysis after laparoscopic bariatric surgery. Obes Surg 2004;14:91–4.CrossRefGoogle Scholar
  30. 30.
    Carvalho DAF, Valezi AC, Brito EM. Rhabdomyolysis after bariatric surgery. Obes Surg 2006;16:740–4.CrossRefGoogle Scholar
  31. 31.
    Lagandré S, Arnalsteen L, Vallet B. Predictive factors for rhabdomyolysis after bariatric surgery. Obes Surg 2006;16:1365–70.CrossRefGoogle Scholar
  32. 32.
    Capella RF, Capella JF, Mandac H. Vertical banded gastroplasty – Gastric bypass: preliminary report. Obes Surg 1991;1:389–95.CrossRefGoogle Scholar
  33. 33.
    Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine 1982;6:141–52.CrossRefGoogle Scholar
  34. 34.
    Warren JD, Blumbergs PC, Thompson PD. Rhabdomyolysis: a review. Muscle Nerve 2002;25:332–47.CrossRefGoogle Scholar
  35. 35.
    Targa L, Droghetti L, Caggese G, et al. Rhabdomyolysis and operating position. Anaesthesia 1991;46:141–3.CrossRefGoogle Scholar
  36. 36.
    Laurence AS. Serum myoglobin and creatine kinase following surgery. British J Anaesthesia 2000;84:763–6.CrossRefGoogle Scholar
  37. 37.
    Pietro F, Antonio F, Vincenzo P, Antonietta R. Rhabdomyolysis after sleeve gastrectomy: increased in muscle enzymes does not predicit fatal outcome. Obes Surg 2008;18:349–51.CrossRefGoogle Scholar
  38. 38.
    Ettinger JM, Santos PF, Azaro E. Prevention of rhabdomyolysis in bariatric surgery. Obes Surg 2005;15:874–9.CrossRefGoogle Scholar
  39. 39.
    Adami GF, Ravera G, Marinari GM, et al. Metabolic syndrome in severely obese patients. Obes Surg 2001;11:543–5.CrossRefGoogle Scholar
  40. 40.
    Macgregor AM, Thoburn EK. Meralgia paresthetica following bariatric surgery. Obes Surg 1999;9:364–8.CrossRefGoogle Scholar
  41. 41.
    Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: An evaluation of 475 hospitalized patients. Medicine 2005;84:377–85.CrossRefGoogle Scholar
  42. 42.
    Amor VM, Iniesta HJ, Santiveri X. Morbidity and mortality related to anesthesia and surgery in 60 patients treated with bariatric surgery. Rev Esp Anestesiol Reanim 2002;49:365–72.Google Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Leonardo Dornas de Oliveira
    • 1
  • Marco Túlio C. Diniz
    • 2
  • Maria de Fátima H. S. Diniz
    • 3
  • Alexandre L. Savassi-Rocha
    • 2
  • Sarah T. Camargos
    • 1
  • Francisco Cardoso
    • 1
    • 4
    Email author
  1. 1.Neurology Service, Internal Medicine Department, Faculty of MedicineFederal University of Minas GeraisBelo HorizonteBrazil
  2. 2.Obesity Surgery Service, General Surgery Department, Faculty of MedicineFederal University of Minas GeraisBelo HorizonteBrazil
  3. 3.Endocrine Surgery Service, Internal Medicine Department, Faculty of MedicineFederal University of Minas GeraisBelo HorizonteBrazil
  4. 4.Belo HorizonteBrazil

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