Rhabdomyolysis: Diagnosis and Treatment in Bariatric Surgery

Ettinger, João Eduardo Marques Tavares de Menezes; Souza, Carlos Alfredo Marcílio de; Santos-Filho, Paulo V.; Ázaro, Euler; Mello, Carlos Augusto Bastos; Fahel, Edvaldo; Batista, Paulo Benígno Pena

doi:10.1007/s11695-007-9091-5

Cited by 34 publications

(21 citation statements)

References 49 publications

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“…The number of operations for obesity has increased in recent years 5,47 and its success is founded on the effective weight loss, control of comorbidities and increased quality of life 1,5,9,29,47 . However, some negative effects have also been reported in several studies, such as hyperparathyroidism and osteoporosis 39,55,57,59 chronic regurgitation, nutritional deficiencies 2,6,28,30,59 , kidney problems 3,16 and oral problems 22,23,31,49 . The objective of this review was to identify the consequences of postoperative bariatric surgery (as vitamin deficiency, gastroesophageal reflux, kidney disturbances, psychological alterations, reduction of diabetes mellitus, improvement in obstructive sleep apnea and, also, to check its impact on oral health and dental caries, xerostomy, erosion and bone resorption.…”

Section: Introductionmentioning

confidence: 99%

Consequências sistêmicas da cirurgia bariátrica e suas repercussões na saúde bucal

Moura-Grec

Assis

Cannabrava

et al. 2012

ABCD, arq. bras. cir. dig.

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-Introduction -Morbid obesity control can be done by bariatric surgery that restricts or reduces the amount of food absorption. The objective of this review was to identify the consequences of bariatric surgery and its repercussions on oral health. Method -It was used the Virtual Library of Health, which included articles that had any direct or indirect connection between bariatric surgery and oral health, and published in the last ten years. Results -Some complications of the surgery are chronicle reflux and nutritional deficiency, which may bring repercussions on the oral cavity, such as tooth erosion, bone loss and dental caries. On the other hand, there are also positive impacts, such as the decrease of diabetes, apnea and improvement on self-esteem, that makes the patients less vulnerable to complications regarding oral health, for example xerostomy and periodontal disease. Conclusion -Maintaining proper oral health in patients undergoing bariatric surgery contributes to success after surgery protecting benefits and minimizing side effects. ABCDDV/868RESUMO -Introdução -O controle da obesidade mórbida pode ser realizado através da cirurgia bariátrica que leva à restrição e/ou à má-absorção de alimentos. O objetivo dessa revisão foi identificar consequências desse procedimento e suas repercussões na saúde bucal. Método -Foi realizada busca na Biblioteca Virtual em Saúde, sendo incluídos artigos com relação direta ou indireta entre cirurgia bariátrica e saúde bucal e publicados nos últimos dez anos. Resultados -Verificaram-se algumas complicações decorrentes dessa operação, como regurgitação crônica e deficiências nutricionais, que podem trazer repercussões na cavidade bucal como erosão dentária, perda óssea e cárie dentária. Por outro lado, existem consequências positivas como controle da diabetes, da apnéia e melhora da auto-estima, que tornam os pacientes menos susceptíveis à complicações na cavidade oral, como xerostomia e doença periodontal. Conclusão -A manutenção da saúde bucal adequada em pacientes submetidos à cirurgia bariátrica contribui para o sucesso após a operação, resguardando os benefícios e minimizando os efeitos colaterais.

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Section: Introductionmentioning

confidence: 99%

Consequências sistêmicas da cirurgia bariátrica e suas repercussões na saúde bucal

Moura-Grec

Assis

Cannabrava

et al. 2012

ABCD, arq. bras. cir. dig.

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“…As a consequence, CPK is more reliable than myoglobin in the assessment of the presence and the extent of muscular damage [16]. Thus, CPK is a significant marker of RML; it is useful to perform the diagnosis of RML and follow the evolution over time.…”

Section: Discussionmentioning

confidence: 99%

“…The CK levels to diagnose RML vary among authors, some of them accept CPK > 1000 UI/l (five times the normal value); other ones accept CPK > 5000 UI/l and even > 10000. Lower values are safer for an early diagnosis in order to avoid RML complications [16]. Surely, RML prevention is very important and it may avoid negative patient outcome.…”

Section: Introductionmentioning

confidence: 99%

Rhabdomyolysis Following Bariatric Surgery: a Retrospective Analysis

Forfori¹,

Sayburn²,

Taddei³

et al. 2013

TOOBESJ

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Abstract:Background: Rhabdomyolysis (RML) indicates a skeletal muscle necrosis which results in an emission of intracellular contents from myocytes into the circulatory system. It has been recognized to be a complication of bariatric surgery. A high BMI and a prolonged operative time are the main risk factors associated to the development of RML. The aim of this study is to define the incidence and the main features of RML in a cohort of obese patients undergoing bariatric surgery.Materials and Methods: a retrospective observational analysis was carried out on 100 patients undergone bariatric surgery. The bariatric operations were open or laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG); they were performed at the university hospital Nuovo S. Chiara in 2011.Results: 6 of 100 patients enrolled developed RML. Three of these also showed acute kidney injury due to RML (50%). A significant correlation between post-operative increased creatine phosphokinase (CPK) levels and BMI was found (r=0.369; r 2 =0,137; p=0.005) as well as a significant correlation between the increased levels of creatine phosphokinase, myoglobin and operative time (increased operative time -highest CPK: r=0.550; r 2 =0.302; p<0.0001; increased operative time -highest myoglobin: r=0.553; r 2 =0.305; p<0.0001). Moreover, hypertension and prolonged operative time were found to be variables associated with RML in bivariate analysis. Conclusions:The incidence of RML following bariatric surgery was 6%. Since rhabdomyolysis is the most important complication of bariatric surgery, appropriate precautions should be taken during surgery. Post-operative monitoring of CPK and myoglobin levels is essential for an early diagnosis of RML.

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“…Управление гликемией до и в день операции осуществлялось (при необходи-мости) инсулинотерапией, которая в последующем по-слеоперационном периоде была постепенно отменена у всех пациентов. Статины были отменены за 5-7 дней до операции из-за их возможного миопатического действия, повышающего риск развития рабдомио-лиза, специфического осложнения в бариатрической хирургии [17]. Забор крови производился из локтевой вены утром натощак после не менее 12 часов голодания в вакуумные пробирки с инертным гелем.…”

Section: материалы и методыunclassified

“…Забор крови производился из локтевой вены утром натощак после не менее 12 часов голодания в вакуумные пробирки с инертным гелем. Полученные пробы крови центрифугировались при температуре +4°С на скорости 3000 оборотов в минуту в течение [15][16][17][18][19][20] Уровень КА на ранних сроках после БПШ не изме-нялся (табл. 1).…”

Section: материалы и методыunclassified

Lipid metabolism and production of incretins in patients with obesity and type 2 diabetes mellitus after biliopancreatic diversion in Hess-Marceau modification at the early stages of follow-up

Ершова¹,

Трошина²,

Yashkov³

2016

Obes. metabol.

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Objectives: To study the lipid metabolism and secretion of GLP-1 and GIP in obese patients with type 2 diabetes before and 3 months after biliopancreatic diversion (BPD) in Hess-Marceau modification.Materials and methods: 22 patients (44 [38.0; 55.0] years) with morbid obesity (BMI of 50.1 [41.3; 53.8]) and type 2 diabetes were included in the study. Total cholesterol, LDL-C, HDL-C, TG, GLP-1, GIP were evaluated before and 3 months after BPD.Results: At 3 months after BPD there were decreases in weight by 15.8% and a reduction in total cholesterol levels and LDL-C, an increase in the number of patients with a target value of total cholesterol and LDL-C (from 4/22 (18%) to 20/22 (91%, p = 0.0001)). TG levels during the first 3 months after BPD did not change, but there was a trend to an increase in the number of patients with TG target levels (from 8/22 (32%) to 15/22 (68%, p = 0.058)). Due to the reduction of total cholesterol intake after malabsorbtive surgery, we saw a regular decrease in HDL-cholesterol. 3 months after BPD there was an increase in basal secretion of GLP-1 and GIP as compared to preoperative levels, and a strong positive association of the basal GIP with the HDL-C (r = 0,8, p = 0.007) and a strong negative association – with the atherogenic index (r = – 0,7, p = 0.009) at 3 weeks after surgery.Conclusions: The majority of patients with obesity and type 2 diabetes as early as at 3 months after BPD in the modification by Hess-Marceau achieve a significant improvement in the parameters of lipid metabolism; expect positive impact of the GIP on lipid metabolism.

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Rhabdomyolysis: Diagnosis and Treatment in Bariatric Surgery

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

Cited by 34 publications

References 49 publications

Consequências sistêmicas da cirurgia bariátrica e suas repercussões na saúde bucal

Consequências sistêmicas da cirurgia bariátrica e suas repercussões na saúde bucal

Rhabdomyolysis Following Bariatric Surgery: a Retrospective Analysis

Lipid metabolism and production of incretins in patients with obesity and type 2 diabetes mellitus after biliopancreatic diversion in Hess-Marceau modification at the early stages of follow-up

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