Portomesenteric Vein Thrombosis after Bariatric Surgery: An Online Survey

Abstract

Portomesenteric vein thrombosis (PMVT) is a rare post-operative complication of bariatric procedures, occurring in between 0.3% and 1% of cases. A structured questionnaire consisting of 27 items was available online to members of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) to investigate the occurrence of PMVT. A total of 89 bariatric surgeons from 61 countries participated. Twenty-six (29.21%) reported at least one case of PMVT (46.15% males; 53.84% females). The surgery most associated with PMVT occurrence was sleeve gastrectomy (84.6%), followed by Roux-en-Y gastric bypass (RYGB) (7.69%), and laparoscopic adjustable gastric banding (LAGB) (7.69%). The time gap between surgery and PMVT was 19.28 ± 8.72 days. The predominant symptom was abdominal pain in 96.15% of patients, followed by fever in 26.9%. Complete occlusion of the portal vein was reported in 34.6% of cases, with involvement of the portal system in 69%, extension to the superior mesenteric district in 23%, and extension to the splenic vein in two patients (7.7%). Our survey, which is the largest regarding PMVT to date, revealed a diffuse lack of standardization in the choice, duration, and dosing of prophylaxis regimens as well as treatment modalities, reflecting the literature gap on the topic.

An unusual case of severe gastrointestinal bleeding

“…PVT can occur in patients with or without cirrhosis. Causes are local (liver cirrhosis, malignancy, infections, injury and abdominal surgery) and systemic (thrombophilia, myeloproliferative disease, hormonal disorders and paroxysmal nocturnal hemoglobinuria) [13,14,15,16,17]. Our patient is thought to have suffered PVT because of surgery (formation of CJS).…”

Nontransplant options for portomesenteric thrombosis

“…PMT is a well-known and long-standing complication of cirrhosis and has been extensively described particularly in the setting of liver transplantation [1][2][3][4]. More recently, PMT has been gaining attention as a serious complication of bariatric surgery in the era of global obesity epidemic [5][6][7], which might result in small bowel or liver transplantation in the worstcase scenario [8,9]. PMT has also been reported in patients with inflammatory bowel disease, which the global incidence is also rising [10,11].…”