Laparoskopik Sleeve Gastrektomi Sonrası Portomezenterik Venöz Tromboembolinin Non-Operatif Yönetimi ve Uzun Dönem Anti Koagülan Proflaksinin Önemi

Abstract

Aim: Portomesenteric venous thrombosis (PMVT) is a rare and life-threatening complication of laparoscopic sleeve gastrectomy (LSG). Treatment is usually established with proper anticoagulant prophylaxis. In this study, we aimed to focus on the incidence, clinical characteristics, follow-up, and treatment of patients who have undergone LSG procedures and developed PMVT. Material and Methods: Between the years of 2010 -2019, we retrospectively screened 683 patients who had undergone LSG operation due to obesity. In all patients, the diagnosis was established with abdominal computerized tomography (CT). Age, gender, body mass index (BMI), thrombosis risk factors, surgical details, PMVT clinical characteristics, follow-up, and treatment features were analyzed in patients diagnosed with PMVT. Results: LSG was performed on 683 patients and four patients (0.58%) developed PMVT. The average age of patients was 36.25±6.89 (29-45) years and only three patients were female. The average BMI was 36.42±0.95 (35.1-37.3) kg/m 2 . Three patients had a smoking history. All patients received anticoagulant therapy and responded to conservative treatment. The average length of stay in the hospital was 2.75±0.5 days (2-3). The average length of stay on the second admission to the hospital was 8.75 days (5-8 days). One patient had the diagnosis of protein C deficiency. No mortality or morbidity was observed. Conclusion:PMVT is a rare but serious complication following bariatric surgery. Conservative treatment is fundamental. Treatment is required based on any underlying disease if present. Surgical intervention is required for small bowel necrosis. The findings of our study support the information that long-term anticoagulant prophylaxis plays a role in preventing PMVT after LSG, as well as improving prognosis on patients who have already developed PMVT. To evaluate the long-term effects of PMVT on patients, a longer time of follow-up and a larger patient population is needed.