Portomesenteric Vein Thrombosis Post-Laparoscopic Sleeve Gastrectomy: Case Series and Literature Review

Al-Sabah, Suleiman; AlRuwaished, Mohammed; Almazeedi, Sulaiman; Haddad, Eliana Al; Chouillard, Élie

doi:10.1007/s11695-017-2637-2

Cited by 12 publications

(7 citation statements)

References 42 publications

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“…Broe et al found in their study that PVST originated from the splenic vein and gradually spread into the portal vein and vena mesenterica superior [ 23 ]. The cause of the splenic vein thrombosis group is uncertain but can be explained as follows: (1) CO2 pneumoperitoneum may cause hypercoagulability in the patient's blood [ 24 ]; (2) mechanical injury of splenic vein vessels with an endoscopic cutting closure device results in exposure of subintimal collagen that activates the clotting system; and (3) Ultrasonic scalpel and Ligasure may cause thermal or oscillatory injury of venous intima [ 8 ]. As a result of the splenic vein's larger diameter, when the splenic vein is cut, the splenic vein blood flow is rapidly reduced, which may promote PVST formation [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Early prevention and risk factors analysis of portal vein system thrombosis after laparoscopic splenectomy and pericardial devascularization

Liu

et al. 2022

Surg Endosc

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Background Portal vein system thrombosis (PVST) is a common postoperative complication brought by laparoscopic splenectomy and pericardial disconnection (LSD) among patients who suffered from portal hypertension and hypersplenism. This research lies mainly in probing into the risk factors of PVST and evaluating the effects of warfarin on PVST prevention. Materials and methods We took 131 individuals who have carried out LSD from January 2015 to January 2021. Patients were divided into warfarin group (n = 68) and aspirin group (n = 63). Meanwhile, thrombosis factors were analyzed in PVST arm (n = 48) and non-PVST arm (n = 83). Results We analyzed the early postoperative anticoagulation effect, 20 patients (29.4%) in the warfarin group developed PVST, and 28 patients (44.4%) in the aspirin group. The chance to PVST during the first year after operation was lower in the warfarin group than in the aspirin group (F = 13.43, P = 0.006). Risk factors for PVST were analyzed, and diabetes, the diameter of the portal vein and splenic vein, and the velocity of portal blood flow were statistically significant between the PVST arm and non-PVST arm (P < < 0.05). Multiple logistic regression analyses have shown that diabetes, portal vein diameter, splenic vein diameter, and the velocity of portal blood flow were the risk factors of PVST. Conclusions The portal vein diameter, splenic vein diameter, portal vein flow velocity, and diabetes are risk factors for the PVST after LSD. The prophylactic use of warfarin anticoagulation markedly decreases the probability of occurrence of the PVST in patients with portal hypertension after LSD compared to aspirin. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Early prevention and risk factors analysis of portal vein system thrombosis after laparoscopic splenectomy and pericardial devascularization

Liu

et al. 2022

Surg Endosc

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“…The number of PMVT cases reported after LSG is greater than that reported after other bariatric procedures. The incidence of PMVT after LSG has been reported as 0.3%–1.8% . Specifically, during the LSG procedure, potential etiologies for thrombosis include mechanical or thermal effect on the left gastroepiploic arcade or short vessels, blood flow pattern change, splenic vein direct contact, splenic ischemia or infarction, and dehydration .…”

Section: Discussionmentioning

confidence: 99%

“…ATIII is a natural anticoagulant that inhibits thrombin, factor Xa, and other serine proteases in coagulation cascade.It is difficult to identify PMVT because many patients who undergo LSG complain of vague abdominal pain associated with nausea and decreased oral intake after the surgery. Onset could be as early as 1 day postoperatively, but usually, the median onset of diagnosis is 14 days . Studies have reported that CT enhanced with oral and intravenous contrast used to diagnose and monitor patients’ courses shows sensitivity of 90% .Therapeutic options for PMVT depend on the severity of thrombosis and include simple anticoagulation, catheter‐directed thrombolytic therapy, and thrombectomy with tissue plasminogen activator .…”

Section: Discussionmentioning

confidence: 99%

“…PMVT has been described after various surgical procedures, including splenectomy, appendectomy, cholecystectomy, colectomy, Nissen fundoplication, and bariatric procedures . PMVT has been reported after bariatric procedures such as laparoscopic Roux‐en‐Y gastric bypass, gastric banding, and LSG . Central obesity is associated with an increased risk of PMVT , and consequently, all bariatric surgery patients carry an increased risk.…”

Section: Introductionmentioning

confidence: 99%

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Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy in patient with liver cirrhosis

Amiki

Seki

Kasama

et al. 2018

Asian J Endoscop Surgery

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Laparoscopic sleeve gastrectomy (LSG) has become the dominant bariatric procedure because of its reliable weight loss and low complication rate. Portomesenteric vein thrombosis (PMVT) after LSG is an infrequent complication that can lead to serious consequences. Here, we report a patient who presented with abdominal pain 11 days after LSG for the treatment of morbid obesity. Contrast CT of the abdomen revealed PMVT. The patient had liver cirrhosis, which is a major risk factor for PMVT. When LSG is performed on an obese patient with liver cirrhosis, careful attention must be paid to the onset of PMVT.

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“…PMVT is a rare but life-threatening complication after bariatric surgery and is known to be much more common after SG than after other bariatric procedures, including RYGB. The incidence was reported as 0.3–0.4% in the previous studies that retrospectively reviewed a very large number of SG patients [ 49 50 51 52 ]. It mostly occurs within the first postoperative month, and the clinical presentation can vary.…”

Section: Pmvtmentioning

confidence: 99%

Diagnosis and Management of Postoperative Complications After Sleeve Gastrectomy

Park

2022

J Metab Bariatr Surg

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Sleeve gastrectomy (SG) has demonstrated excellent outcomes in terms of weight loss and resolution of obesity-related comorbidities as a single procedure. It has gained rapidly increasing popularity among bariatric surgeons and patients over the last two decades. This is due to its relative ease of use and less frequent morbidities related to the procedure. Even though the overall complication rate after SG is reported to be lower than conventional Roux-en-Y gastric bypass or biliopancreatic diversion, it still affects 1–10% of the patients undergoing SG, which is not negligible. Early postoperative complications that can occur within 30 days after SG include hemorrhage, leakage, sleeve stenosis, and reflux. Thromboembolic events are rare but can occur after surgery. Here, we review the incidence, diagnosis, and management of these early postoperative complications.

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Portomesenteric Vein Thrombosis Post-Laparoscopic Sleeve Gastrectomy: Case Series and Literature Review

Cited by 12 publications

References 42 publications

Early prevention and risk factors analysis of portal vein system thrombosis after laparoscopic splenectomy and pericardial devascularization

Early prevention and risk factors analysis of portal vein system thrombosis after laparoscopic splenectomy and pericardial devascularization

Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy in patient with liver cirrhosis

Diagnosis and Management of Postoperative Complications After Sleeve Gastrectomy

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