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Rahul N. Khurana, MD; Thomas E. Baudendistel, MD; Elise F. Morgan, PhD; Robert A. Rabkin, MD; Ronald B. Elkin, MD; Oliver O. Aalami, MD

Arch Surg. 2004;139:73-76.

Hypothesis  Laparoscopic approaches for weight reduction in the morbidly obese have become common with more than 50 000 bariatric surgical procedures being performed in 2001. The objective of this article is to raise awareness among surgeons of a new complication of rhabdomyolysis from this frequent procedure.

Design  Case series extracted from surgical database from January 2, 2001, through December 31, 2002.

Patients and Methods  We identified 5 cases of postoperative rhabdomyolysis in morbidly obese patients who underwent laparoscopic duodenal switch procedures with parietal gastrectomy. The cause, pathogenesis, and clinical features are reviewed and discussed.

Results  Postoperative rhabdomyolysis developed in 5 of 353 morbidly obese patients who underwent consecutive laparoscopic duodenal switch procedures, an incidence of 1.4%. All 5 patients were male, had a mean peak serum creatine kinase level of 19 680 U/L, and reported muscle pain in either the buttock, hip, or shoulder regions during the early postoperative period.

Conclusions  We hypothesized that morbidly obese patients develop critical surface and deep tissue pressures during bariatric surgery, increasing their risk for tissue injury and rhabdomyolysis. Unexplained elevations in the serum creatinine level or reports of buttock, hip, or shoulder pain in the postoperative period should raise the possibility of rhabdomyolysis and prompt clinical investigation. We recommend routine preoperative and postoperative measurements of the serum creatine kinase and serum creatinine levels to aid detection. Surgeons need to keep a low index of suspicion because early diagnosis and treatment are the cornerstones of successful management of rhabdomyolysis.

From the Departments of Medicine (Drs Khurana, Baudendistel, and Elkin) and Surgery (Dr Rabkin), California Pacific Medical Center, San Francisco; Department of Mechanical Engineering, Stanford University School of Medicine, Palo Alto, Calif (Dr Morgan); and the Department of Surgery, University of California, San Francisco–East Bay (Dr Aalami).

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