Freqüência de rabdomiólise em pacientes submetidos a tratamentooperatório para obesidade mórbida no Hospital das Clínicas da UFMG

Abstract

Obesity is an epidemic worldwide disease associated with co-morbidities and increased mortality. Because it is chronic and recurrent and has little response to clinical measures, surgical treatment (bariatric surgery) is a therapeutic option more and more used.Different surgical complications have been associated with this type of procedure but there is little knowledge about neurological complications. Among them, rhabdomyolysis (RML) has been described not long ago and many times as case reports, with few longitudinal studies. Compressive mechanisms associated with supine position and bigger corporal weight probably play a role in the pathogenesis of this complication. This study evaluated 22 patients who underwent surgical treatment for morbid obesity at Hospital das Clínicas of UFMG with open Roux-en-Y gastric bypass (RYGBP) to analyze the frequency of RML using the creatine phosphokinase (CPK) after 24 hours of surgery. Fourteen women and 8 men were evaluated, with median age of 39.9 ± 11.2 years, median Body Mass Index (BMI) of 52.4 ± 8.0 kg/m² and mean surgical time of 253.2 ± 51.9 minutes. RML was diagnosed as an increase of more than five times the superior limit of normal range and occurred in 77.3% of the patients. The mean value of postoperative CPK was very high (7467.7 ± 12177.1 IU/L), being greater than 5000 IU/L in 40.5% of the patients, showing a significant muscular injury and an elevated risk of complications. No patient had renal failure related with RML but there was one death (4.5%) associated with abdominal infectious complications. Clinical neuromuscular symptoms occurred in 45.5% of patients and muscular pain was more common, especially in gluteus regions. Comparative analyzes between patients with and without RML diagnosis show statistic significance of longer surgical time (p=0.005) and occurrence of neuromuscular symptoms in RML group (p=0.04). The results of this study are similar of few others available and confirmed that occurrence of RML in open bariatric surgery with RYGBP (Capella) is a common complication and emphasize the importance of measurement the CPK after 24 hours of surgery.