Objective:

To report the perioperative management of a patient with VLCADD undergoing laparoscopic sleeve gastrectomy and highlight the unique challenges and strategies involved, such as metabolic monitoring and tailored anaesthetic approaches.

Key Findings:

• The patient experienced significant rhabdomyolysis post-surgery, with CK levels rising to 7300 U/L, indicating severe metabolic stress.
• Postoperative complications included a urinary tract infection and elevated CK levels, but she improved with treatment, highlighting the need for vigilant postoperative monitoring.
• At follow-up, the patient showed significant weight loss (25.4%) and improved metabolic control, demonstrating the potential benefits of bariatric surgery in this population.

Interpretation:

Patients with VLCADD require specialized perioperative management strategies, including metabolic monitoring and tailored anaesthetic approaches, to mitigate risks of metabolic crises and rhabdomyolysis during and after surgery.

Limitations:

• This is a single case report, limiting generalizability and the ability to draw broader conclusions.
• Long-term outcomes and broader implications for bariatric surgery in VLCADD patients remain to be studied, and potential biases in case selection should be considered.

Conclusion:

Bariatric surgery can be safely performed in VLCADD patients with careful perioperative management, leading to improved metabolic outcomes and quality of life.