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- Title
Is Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy Related to Short-Course Prophylaxis of Thromboembolism? A Monocentric Retrospective Analysis About an Infrequent but Not Rare Complication and Review of the Literature.
- Authors
Caruso, Francesco; Cesana, Giovanni; Lomaglio, Laura; Cioffi, Stefano; Ciccarese, Francesca; Uccelli, Matteo; Olmi, Stefano
- Abstract
<bold>Background: </bold>Portomesenteric vein thrombosis (PMVT) is considered a rare and potentially fatal complication of bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is one of the most performed bariatric procedures in the world. PMVT in LSG was first reported in 2009 by Berthet et al. in a thrombophilic patient. No data exist regarding the real prevalence of this complication specifically after LSG.<bold>Methods: </bold>We examined retrospectively all the clinical records of patients who underwent LSG for morbid obesity from January 2011 to December 2016. Moreover, we performed a literature search of PubMed, Medscape, and EMBASE databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.<bold>Results: </bold>2854 patients underwent LSG for morbid obesity from January 2011 to December 2016. The retrospective analysis of our records revealed only 1 case of PMVT. The 18 studies selected include 62 cases of PMVT after LSG with a prevalence of 0.52% (ranging from 0.2% to 1.81%) and a mortality rate of 1.61%.<bold>Conclusions: </bold>PMVT is an infrequent but not rare complication in patients who undergo LSG. Short-course antithrombotic prophylaxis (<10 days) could increase the risk of this complication. The authors recommend a postoperative prophylaxis with sodium enoxaparin 40 mg sc once a day for 4 weeks. PMVT mortality in patients who undergo LSG is lower than other causes of portal vein thrombosis (hepatic cirrhosis, tumors, myeloproliferative disorders, etc.) If risk factors for PMVT are present preoperatively, the authors recommend a prophylaxis with sodium enoxaparin 40 mg sc twice daily for 4 weeks.
- Subjects
BARIATRIC surgery; GASTRECTOMY; MORBID obesity; FIBRINOLYTIC agents; PORTAL vein diseases; ANTICOAGULANTS; LAPAROSCOPY; PORTAL vein; SPLENIC vein; VENOUS thrombosis; SYSTEMATIC reviews; DISEASE prevalence; RETROSPECTIVE studies; MESENTERIC veins; MESENTERIC ischemia
- Publication
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2017, Vol 27, Issue 10, p987
- ISSN
1092-6429
- Publication type
journal article
- DOI
10.1089/lap.2017.0190