Portomesenteric Vein Thrombosis in Patients Undergoing Sleeve Gastrectomy: an Updated Systematic Review and Meta-Analysis of 101,914 Patients

Geropoulos, Georgios; Kakos, Christos D; Lu, Weiying; Hadwe, Salim El; Fornasiero, Massimiliano; Robertson, Andrew; Parmar, Chetan

doi:10.1007/s11695-023-06714-z

Cited by 7 publications

(6 citation statements)

References 113 publications

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“…The latter is a rare but potentially serious complication associated with MBS and almost exclusively with SG. Although the precise mechanism responsible for the increased risk of portal thrombosis in SG is still debated, in these selected patients, liver as prothrombotic factor must play a crucial role 27 as in the present series this complication occurred in three out of 40 patients undergoing SG (7.5 of SG and 5% of the whole series). These findings should be taken into account when choosing which procedure should be performed in patients with CSPH.…”

Section: Discussionmentioning

confidence: 53%

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety

Temime,

Ghanem,

Heimbach

et al. 2024

International Journal of Surgery

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Background: The obesity epidemic has led to an increase in the proportion of patients with chronic liver disease due to metabolic associated steatosic liver disease and in the prevalence of obesity in patients with cirrhosis. Metabolic and bariatric surgery has been proven to determine weight loss, obesity-related medical problems remission, and liver steatosis, inflammation, and fibrosis improvement. However, cirrhosis and portal hypertension are well-known risk factors for increased morbidity and mortality after surgery. The aim of this study is to evaluate the safety of metabolic and bariatric surgery in patients with compensated advanced chronic liver disease and clinically significant portal hypertension. Material and Methods: This is an international, multicentric, retrospective study on 63 individuals affected by obesity with compensated advanced chronic liver disease and clinically significant portal hypertension who underwent metabolic and bariatric surgery in tertiary referral centers with experts hepatobiliary surgeons between January 2010 and October 2022. The primary endpoint was post-operative mortality at 90 days. The secondary endpoints included postoperative weight loss at last follow-up and postoperative complication rate. In addition, we performed subgroup analyses of Child-Pugh (A vs. B) score, MELD (≤9 vs. >9) score and type of surgery. Results: One patient (1.6%) experienced gastric leakage and mortality. There were 3 (5%) reported cases of portal vein thrombosis, 2 (3%) postoperative acute renal failure, and 1 (1.6%) postoperative encephalopathy. Child-Pugh score A resulted to be a protective factor for intraoperative bleeding requiring transfusion at univariate analysis ((OR: 0.73, 95% CI: 0.55 – 0.97, P=0.046) but not at multivariate analysis. MELD>9 score and the type of surgery did not result to be a risk factor for any postoperative complication. Conclusion: Metabolic and bariatric surgery is safe in patients with compensated advanced chronic liver disease and clinically significant portal hypertension performed in tertiary bariatric referral centers with hepatobiliary expert surgeons. Larger, prospective studies with longer follow-up periods are needed to confirm these results.

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Section: Discussionmentioning

confidence: 53%

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety

Temime,

Ghanem,

Heimbach

et al. 2024

International Journal of Surgery

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“…Diagnosing PT in the postoperative period can be challenging due to its limited symptomatology; thus, the incidence is underestimated [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, no statistically significant association with PT was confirmed (p 0.61). Conversely, advanced age and low center volume showed significant variables, p-values of 0.02 and < 0.0001, respectively [ 2 ]. In the present case, several of these factors contributed to the development of portal thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Anticoagulation is the primary treatment for PT post-bariatric surgery [ 2 ] and is safe and effective in patients with esophageal varices [ 7 ]. Surgical indication depends on the thrombosis extent and intestinal ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…It is seen in about 5–15% of cases of mesenteric ischemic events [ 1 ]. In the context of laparoscopic bariatric surgery, PT is considered rare, with an incidence of 0.5% [ 2 ]. This complication may be attributed to a hypercoagulable and inflammatory state in these patients.…”

Section: Introductionmentioning

confidence: 99%

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Portosystemic shunt surgery for severe portal hypertension due to portal thrombosis after bariatric surgery

Reyes,

Jarufe,

Briceño

et al. 2024

Journal of Surgical Case Reports

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Portal vein thrombosis is a rare complication after laparoscopic sleeve gastrectomy, a widely performed bariatric surgery procedure. Occasionally, the development of portal vein thrombosis can progress to more severe conditions, including portal hypertension and cavernomatosis, thereby presenting a complex and challenging clinical scenario. The management of such complications often requires careful consideration; however, surgical intervention in the form of a splenorenal shunt is an exceptional indication. We present the case of a 33-year-old female patient who had previously undergone laparoscopic sleeve gastrectomy in 2014 and subsequently developed portal thrombosis, followed by cavernomatosis and associated complications of portal hypertension. A proximal splenorenal shunt procedure and splenectomy were successfully performed to manage portal hypertension. The presentation of this clinical case aims to contribute to the available evidence and knowledge surrounding this rare and challenging pathology.

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Guidelines for Management of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) Occurring After Metabolic Bariatric Surgery (MBS)

Parmar,

Felsenreich,

Salminen

et al. 2024

OBES SURG

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Portomesenteric Vein Thrombosis in Patients Undergoing Sleeve Gastrectomy: an Updated Systematic Review and Meta-Analysis of 101,914 Patients

Cited by 7 publications

References 113 publications

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety

Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety

Portosystemic shunt surgery for severe portal hypertension due to portal thrombosis after bariatric surgery

Guidelines for Management of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) Occurring After Metabolic Bariatric Surgery (MBS)

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