Incidence of Deep Vein Thrombosis After Laparoscopic vs Minilaparotomy Cholecystectomy

Abstract

Objectives: To determine the frequency of deep vein thrombosis (DVT) associated with minimally invasive cholecystectomy and to determine, using minilaparotomy cholecystectomy as a control operation, the influence of the laparoscopic pneumoperitoneum on DVT formation. Design: Prospective nonrandomized control trial. Setting: Tertiary care university hospital. Patients: One hundred consecutive patients intended to undergo either laparoscopic cholecystectomy (59 patients) or minilaparotomy cholecystectomy (41 patients) with either of 2 surgeons were prospectively enrolled between April 1996 and April 1997. The minilaparotomy cholecystectomy group served as controls to isolate the effect of the pneumoperitoneum. Patient details, operative details, and any thromboembolic or bleeding complications were recorded. The same thromboprophylaxis regimen was prescribed for each group; namely, preoperative and postoperative subcutaneous low-molecular-weight heparin (LMWH), graduated compression stockings, and intraoperative intermittent calf compression. Intervention: Minimally invasive cholecystectomy. Main Outcome Measure: Frequency of DVT. Bilateral lower limb venous color duplex scanning was used to detect DVT. Scans were performed on 3 occasions: (1) preoperatively on admission to hospital, (2) on the first postoperative day, and (3) between 2 and 4 weeks postoperatively. Results: Three patients in the laparoscopic group and 2 patients in the minilaparotomy group underwent con-This article is also available on our Web site: www.ama-assn.org/surgery.

Pulmonary Embolism and Deep Venous Thrombosis Following Laparoscopic Cholecystectomy

“…There was an increased risk of bleeding in those who received anticoagulant prophylaxis. 7 Fatal PE was not reported following laparoscopic cholecystectomy [9][10][11][12][13][14][15][16][17]18 (Table 4), but we observed in-hospital PEassociated death in 0.02%. Pathophysiological factors that may lead to VTE following laparoscopic cholecystectomy include obstruction to venous outflow during surgical pneumoperitoneum and activation of the coagulation system.…”

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

“…These effects result in a decreased tidal volume, ventilation± perfusion mismatch, a decreased shunt volume, increased dead space, and decreased pulmonary compliance (1b [160], 2b [250]). Pulmonary gas exchange during laparoscopy can be optimized by the choice of the anesthetic procedure (1b [93]) and PEEP (5 [183]). Without hyperventilation P a CO 2 will increase by 8±10 mmHg and pH will decrease (1b [315]) before a steady state is reached.…”

Portal vein thrombosis and pulmonary artery thromboembolism after laparoscopic colectomy

“…Studies were performed to examine if laparoscopic surgery is positively correlated with deep vein thrombosis (24,25); however, a significant relationship was not observed. This finding was attributable to the preventive management of the patients; this included intermittent mechanical compression.…”