Assessing risk factors, presentation, and management of portomesenteric vein thrombosis after sleeve gastrectomy: a multicenter case-control study

Moon, Rena; Ghanem, Muhammad; Teixeira, André; Cruz‐Muñoz, Nestor de la; Young, Meredith; Domkowski, Patrick W.; Rädecke, J; Boyce, Stephen G.; Rosenthal, Raúl J.; Menzo, Emmanuel Lo; Blanco, David Gutierrez; Funes, David Romero

doi:10.1016/j.soard.2017.10.013

Cited by 28 publications

(16 citation statements)

References 26 publications

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“…In a recent multicenter casecontrol study about the assessment of risk factors for PVT 2 patient factors significantly impacted the risk of PVT after LSG including personal history of malignancy and type 2 diabetes compared with controls. Thrombophilia was not found amongst these factors (37). Contrary, a systematic review of portomesenteric vein thrombosis after sleeve gastrectomy evaluated 28 studies enclosing 89 patients, found thrombophilia present in at least 56% of PVT patients.…”

Section: Discussionmentioning

confidence: 89%

Portal Vein Thrombosis a Rare but Life-threatening Complication after Laparoscopic Sleeve Gastrectomy: A 5 Years Study in a Bariatric Center of Excellence

Godoroja¹,

Hainarosie²,

Zaharencu³

et al. 2019

chr

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Chirurgia, 114 (6), 2019 trei (0,077 %) au fost readmişi pentru TP la 7-60 zile de la intervenţia bariatrică. Vârsta media a fost 40 ani (SD 11,97), indicele de masa corporală a avut media de 40,34 Kg/m 2 . (SD 7,994). Toţi pacienţii au urmat acelaşi protocol de GLL. Doi pacienţi au primit tratament conservator sistemic.cu heparină şi au ramas pe tratament anticoagulant pe termen lung. Nu a fost nevoie de tratament chirurgical. Al 3 lea pacient a avut o evoluţie fulminantă în terapie intensivă, datorită unei TP extensive, soldată cu deces în două ore de la admisia in spital în ciuda tuturor măsurilor de resuscitare luate. Concluzii: Este necesară o atitudine de suspiciune înaltă clinică pentru pacienţii cu TP după GLL şi un diagnostic şi tratament rapide. Protocolul preventive extins cu doze ajustate de HGMM aplicat in CE-CB şi-a dovedit eficienţa reducand semnificativ incidenta TP după GLL.Cuvinte cheie: tromboza portală, protocol de preventive, gastrectomia longitudinală laparoscopică, centrul de excelenţă, chirurgie bariatrică

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Section: Discussionmentioning

confidence: 89%

Portal Vein Thrombosis a Rare but Life-threatening Complication after Laparoscopic Sleeve Gastrectomy: A 5 Years Study in a Bariatric Center of Excellence

Godoroja¹,

Hainarosie²,

Zaharencu³

et al. 2019

chr

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“…One factor influencing early postoperative liver function capacity in patients after bariatric surgery is the development of portomesenteric vein thrombosis [ 35 ]. This rare but severe condition appears to evolve more frequently after SG than after RYGB, most likely due to locally diminished blood flow after dissection of the greater curvature [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Liver Recovery After Sleeve Gastrectomy and Roux-en-Y-Gastric Bypass

et al. 2021

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Background Nonalcoholic fatty liver disease (NAFLD) is a common condition in patients with obesity. Bariatric surgery has often been proposed as a viable treatment option, but the ideal surgical procedure remains unclear. Inconsistently, reports on postoperative deterioration of liver function put further doubt on which technique to apply. Aim of this study was to assess the impact of Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG) on the postoperative recovery of liver function. Methods A total of 175 patients with obesity that underwent bariatric surgery in our institution were included in this prospective cohort study. BMI, laboratory values, and liver function capacity (using LiMAx) were assessed preoperatively and at 6 and 12 months postoperatively. Generalized linear model (GLM) was performed to determine variables influencing liver function capacity after the operation. Results Prior to operations, 64% of patients presented with a diminished liver function capacity, as measured by LiMAx test. Liver function capacity significantly recovered after 12 months in the SG group (300 μg/kg/h preop vs. 367 μg/kg/h postop) but not in the RYGB group (306 μg/kg/h preop vs. 349 μg/kg/h). Preoperative factors impeding liver function recovery included type 2 diabetes mellitus (T2DM), weight, male sex, AST/thrombocyte ratio (APRI), and gamma-glutamyltransferase (GGT). Conclusion Bariatric surgery, especially sleeve gastrectomy, leads to an improvement of liver function. However, in some patients with T2DM, higher preoperative weight and male sex postoperative deterioration of liver function capacity may occur. Graphical abstract

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“…1 PMVT is a rare but a potentially serious complication with a reported incidence that varies approximately from 0.1% to 1.8%. 1,3,[5][6][7][8][31][32][33][34][35][36][37][38] Diagnosis is difficult due to the non-specificity of its symptoms and the condition can lead to intestinal perforation associated with high mortality rates (11-45%). [1][2][3]36,39 The main treatment is anticoagulant therapy, but surgery is sometimes necessary where there is, for example, bowel ischaemic necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…[26][27][28] In our institution, 5,50 the reported incidence of PMVT after sleeve gastrectomy is around 0.99%, similar to the reported international rate of 0.1-1.8%. 1,3,[5][6][7][8]31,32,[35][36][37][38] The main limitations of this study are that it is not a randomised prospective study and the small number of patients. Of note, there is a current clinical trial investigating the use of rivaroxaban as thromboprophylaxis in bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

Prophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy could reduce the frequency of portomesenteric venous thrombosis

Rodríguez

Kobus

Téllez

et al. 2020

annals

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Introduction Portal and mesenteric venous thrombosis is a rare but potentially serious complication after laparoscopic sleeve gastrectomy. There are no consistent studies that prove the safety and effectiveness of oral anticoagulant thromboprophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy. The objective was to evaluate the effect of rivaroxaban on the frequency of portal and mesenteric venous thrombosis and its safety profile after laparoscopic sleeve gastrectomy. Materials and methods This retrospective analysis of prospectively collected data includes all laparoscopic sleeve gastrectomies performed by a single surgeon at Pontificia Universidad Católica de Chile Hospital between January 2009 and June 2019. All patients received low molecular weight heparin thromboprophylaxis during the whole hospital stay. Between July 2012 and June 2019, patients received additional post-discharge thromboprophylaxis with rivaroxaban. Patient demographics, impaired renal, post-surgical portal and mesenteric venous thrombosis, and bleeding episodes were registered. Results A total of 516 patients were identified; 95 patients were excluded. Results for 421 patients were analysed: 198 received only intrahospital thromboprophylaxis (group 1) and 223 received additional post-discharge thromboprophylaxis with rivaroxaban (group 2). There was no statistically significant difference between the two groups concerning age, sex and body mass index. In group 1, four cases of portal and mesenteric venous thrombosis were registered and no cases were reported in group 2 (p < 0.05). All cases occurred before 30 days after surgery. No bleeding episodes and no adverse reactions were detected in group 2. Conclusions Thromboprophylaxis during the whole hospital stay (two to three days), followed by rivaroxaban 10mg once daily for 10 days after discharge (completing in total 13–14 days of prophylaxis), could reduce cases of post-surgical portal and mesenteric venous thrombosis without an increase in bleeding complications.

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Assessing risk factors, presentation, and management of portomesenteric vein thrombosis after sleeve gastrectomy: a multicenter case-control study

Cited by 28 publications

References 26 publications

Portal Vein Thrombosis a Rare but Life-threatening Complication after Laparoscopic Sleeve Gastrectomy: A 5 Years Study in a Bariatric Center of Excellence

Portal Vein Thrombosis a Rare but Life-threatening Complication after Laparoscopic Sleeve Gastrectomy: A 5 Years Study in a Bariatric Center of Excellence

Comparison of Liver Recovery After Sleeve Gastrectomy and Roux-en-Y-Gastric Bypass

Prophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy could reduce the frequency of portomesenteric venous thrombosis

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