TITLE:
Portomesenteric Venous Thrombosis in Patients after Laparoscopic Bariatric Surgery
AUTHORS:
Augusto Tinoco, Renam C. Tinoco, Luciana El-Kadre, Matheus P. S. Netto, Júlia M. Rocha, Diogo R. de Souza, Douglas G. Tavares
KEYWORDS:
Morbid Obesity, Laparoscopy, Portomesenteric Venous Thrombosis, Bariatric Surgery
JOURNAL NAME:
Surgical Science,
Vol.13 No.9,
September
30,
2022
ABSTRACT: Objective: Obesity has become a worldwide epidemic that is
directly related to chronic tissue inflammation and impaired fibrinolysis, both
of which lead to an increased risk of thrombosis. The management of
complications after bariatric surgery is still a challenge.The study aims to report the incidence of
portomesenteric venous thrombosis (PMVT) in patients undergoing bariatric
surgery. Introduction: Bariatric surgery is the procedure of choice for
the treatment of obesity type III. Despite the safe technique, the surgeon must
be aware of the risks linked to laparoscopy such as the PMVT. Computed
tomography (CT) with intravenous contrast was the imaging method of choice for
diagnosis. Materials and Methods: We performed a
retrospective analysis of 4790 patients from August 1999 to June 2020 was
observed the incidence of PMVT in this group. Of all patients, 72.8% were
female and 27.2% male. The mean age was 46.3 years (34 - 72) and
the mean BMI before bariatric surgery was 41.4 kg/m2. Results: The study showed an incidence of PMVT of 0.12% (N = 6), portal vein thrombosis was of 0.10% (n = 5) and
0.03% of MVT (n = 1). Of these, 72.5% (n = 3473 patients) underwent
laparoscopic gastric bypass, 23.6% (n = 1131 patients) were submitted to the
laparoscopic sleeve gastrectomy and 3.8% (n = 186 patients) to other
procedures. The mean
postoperative hospital stay for bariatric surgery was 3.3 days. The average
time of hospital stay of patients complicated with PMVT range from 5 to 14
days. No patient died of complications related to PMVT. Conclusion: Portomesenteric vein thrombosis is a rare presentation after laparoscopic
bariatric surgery. However, it is a serious complication that has a high index
of suspicion for making its diagnosis. Conservative treatment using
anticoagulants and thrombolytics is effective, it should always be considered
the main treatment option. However, these patients must be followed up in the
long term, as late complications can occur in high numbers of patients.