Comparative Study for Portomesentric Venous Thrombosis after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with BMI 35-45 with and without Anticoagulation, Retrospective Study
Alaa El-din Abdel-Hameed El-Ashry, Mohab Gamal El-Din Mostafa, Hossam Attia Abo El-Azm, Abdelrahman Yahya Mohammed Fouda- General Medicine
Abstract
Background
Portomesentric vein thrombosis is a rare but documented complication of laparoscopic surgery. This rare complication is currently being encountered more frequently with the increase in the rates of laparoscopic bariatric surgery procedures being performed worldwide. Obesity is a worldwide health problem and Bariatric surgery has demonstrated to be an effective and sustainable method for regulation of morbid obesity, especially when it is resistant to both pharmaceuticals and combinations of diet and lifestyle regimens.
Aim of the Work
This study will evaluate the efficacy of use of anticoagulation after LSG in morbidly obese patients with BMI 35-45, to guard against PVT, through retrospective comparative study.
Patients and Methods
A retrospective analysis was performed on all sleeve gastrectomies performed in Ain Shams University Hospitals & some other hospitals between January 2020 & January 2021 to identify cases complicated by Portomesentric venous thrombosis. A total of 60 patients underwent LSG between January 2020 & January 2021 were divided into two groups in a retrospective comparative Pilot study with an average BMI 39.53 kg/m2. Patients from the two groups 10 patients underwent laparoscopic cholecystectomy along with LSG.
Results
There are chemical prophylactic measures can be used pre and post laparoscopic sleeve surgery however, as suggested by some papers post-operative thromboprophylaxis to all patients for 1 week duration and from 3 to 6 months for thrombophilia and high-risk patients, yet specific recommendation regarding VTE prophylaxis after sleeve gastrectomy is in need for prospective trial to guard from developing PVT.
Conclusion
As a phenomenon with an ambiguous and unpredictable symptom, PMVT should be kept in mind in any patient with unexplained abdominal pain after sleeve gastrectomy; in addition, portal venous phase contrast enhanced studies should always be considered when a diagnostic computerized tomography scan is performed. Strong evidence data about PMVT anticoagulant prophylaxis plan is still lacking, however; extended prophylaxis to 2 weeks in a high-risk patient may lower the PMVT incidence.