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

Abstract

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

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

“…Obesity is an independent risk factor for the development of venous thrombosis (10). The risk of development of venous thrombosis in obese patients without surgery is 3%, therefore, bariatric surgeons must be extra careful in terms of the development of thromboembolic events (13). The incidence of development of deep venous thrombosis (DVT) in patients undergoing bariatric surgery is 1.2-1.6% (1).…”

“…Portomesenteric venous thrombosis (PMVT) is caused by partial or complete obstruction of the portal, splenic, and/ or mesenteric vein thrombosis (14). PMVT can be seen after any surgery involving the gastrointestinal tract and may lead to life-threatening conditions such as mesenteric ischemia, intestinal infarct, and liver failure (13). PMVT is a rare and serious complication following bariatric surgery, and the management of it is possible although it is associated with high morbidity and mortality (1,8,10,(15)(16)(17)(18).…”

“…PMVT is a rare and serious complication following bariatric surgery, and the management of it is possible although it is associated with high morbidity and mortality (1,8,10,(15)(16)(17)(18). In the last 10 years, PMVT is seen more often in the postoperative period due to higher numbers of bariatric surgery being performed (13). The incidence of PMVT after bariatric surgery is between 0.3-1% and when compared to other bariatric techniques it is more commonly seen after LSG (13,19).…”

“…Patients may present with abdominal pain, nausea, vomiting, fatigue, fever, and tachycardia (1). It is difficult to diagnose PMVT during the postoperative period due to its nonspecific symptoms; clinical suspicion is important in diagnosis and awareness of bariatric surgery complications makes it easier to diagnose and treat (7,8,(13)(14)(15)(16)21). Symptoms are usually observed on average between 12-15 days postoperatively (13).…”

“…Systemic anticoagulant therapy should be continued for at least 3-6 months after discharge (13,19,20). If there is any underlying thrombophilic disease, anticoagulant therapy is advised to be used lifelong (9,13,21). In the literature, partial and/or total recanalization is established in acute PMVT with anticoagulant treatment (14).…”