Successful Treatment of Gastric Fistula following Rhabdomyolysis after Vertical Banded Gastroplasty

Abstract

Vertical banded gastroplasty is a gastric restrictive operation which has been performed with very satisfactory results in our department. We present a 46 year-old male with BMI 48, who experienced rhabdomyolsis after a VBG operation, complicated by perforation of an upper pouch ulcer and subsequent gastric fistula. Cardiac and renal failure occurred, necessitating intensive therapy with catecholamines, diuretics and hemodialysis. The patient underwent multiple operations, drainage of a retroperitoneal abscess, suture of a perforated ulcer, and gastric decompression by a gastrostomy. Prolonged treatment including TPN, drainage, broad spectrum antibiotics, skin and would protection and jejunostomy feeding, were necessary to obtain an eventual successful outcome. This case demonstrates that unexpected surgical complications may occur in morbidly obese patients and how difficult and long the management of these may be. Rhabdomyolsis is a potentially life-threatening complication of bariatric surgery, and careful postoperative observation of the patient is mandatory.

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

“…Sixty-three percent of our patients were female, similar to many available cases reports [19,20,[23][24][25] and prospective studies [29,30,31]. The preponderance of females is probably a result of a higher prevalence of obesity and MO in this gender.…”

“…As HBP and DM lead to chronic microcirculation abnormalities, they may increase the risk of RML after bariatric surgery [29,31,38], helping to explain the high frequency of RML in our series. Acute renal failure, caused by many etiologies, has been described to occur in 15% to 33% of patients with RML [11,19,21,24,25,28,33]. No one of our patients developed this complication.…”

“…Although RML in BS has been described as a rare complication in case reports [11,[18][19][20][21][22][23][24][25][26][27][28]37] (Table 3), it was diagnosed in 77.3% (17) of our patients, indicating it is a common problem in the postoperative period of this surgical procedure. Similar high frequencies were also found in three other available prospective studies [29,30,31] (Table 4).…”

“…In our series, gender was not a risk factor of occurrence of RML. However, in the prospective study of Carvalho et al [30] and many case reports [11,[19][20][21][22][23][24][25][26][27][28], RML has been more commonly seen in men. A possible explanation for this finding is obesity being more severe in men.…”

“…According to the extension damage, it can be asymptomatic or lifethreatening due to the possibility of hypovolemia, electrolytic disturbs, coagulopathy, and renal failure. RML in BS has been previously described mainly as case reports [11,[18][19][20][21][22][23][24][25][26][27][28] with just a few longitudinal studies about its frequency [29][30][31].…”