Porto-mesenteric venous thrombosis after laparoscopic sleeve gastrectomy: A case report and systematic review of the 104 cases

Introduction Portal and mesenteric venous thrombosis is a rare but potentially serious complication after laparoscopic sleeve gastrectomy. There are no consistent studies that prove the safety and effectiveness of oral anticoagulant thromboprophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy. The objective was to evaluate the effect of rivaroxaban on the frequency of portal and mesenteric venous thrombosis and its safety profile after laparoscopic sleeve gastrectomy. Materials and methods This retrospective analysis of prospectively collected data includes all laparoscopic sleeve gastrectomies performed by a single surgeon at Pontificia Universidad Católica de Chile Hospital between January 2009 and June 2019. All patients received low molecular weight heparin thromboprophylaxis during the whole hospital stay. Between July 2012 and June 2019, patients received additional post-discharge thromboprophylaxis with rivaroxaban. Patient demographics, impaired renal, post-surgical portal and mesenteric venous thrombosis, and bleeding episodes were registered. Results A total of 516 patients were identified; 95 patients were excluded. Results for 421 patients were analysed: 198 received only intrahospital thromboprophylaxis (group 1) and 223 received additional post-discharge thromboprophylaxis with rivaroxaban (group 2). There was no statistically significant difference between the two groups concerning age, sex and body mass index. In group 1, four cases of portal and mesenteric venous thrombosis were registered and no cases were reported in group 2 (p < 0.05). All cases occurred before 30 days after surgery. No bleeding episodes and no adverse reactions were detected in group 2. Conclusions Thromboprophylaxis during the whole hospital stay (two to three days), followed by rivaroxaban 10mg once daily for 10 days after discharge (completing in total 13–14 days of prophylaxis), could reduce cases of post-surgical portal and mesenteric venous thrombosis without an increase in bleeding complications.

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Portomesenteric Venous Thrombosis as a Complication of Laparoscopic Sleeve Gastrectomy: a Case Report and Review of the Literature

Indian Journal of Surgery ◽

10.1007/s12262-019-01976-3 ◽

2019 ◽

Vol 81 (6) ◽

pp. 582-586

Author(s):

Fedele Salvatore ◽

Delvecchio Antonella ◽

Carlino Chiara ◽

Panzera Piercarmine ◽

Martines Gennaro

Keyword(s):

Sleeve Gastrectomy ◽

Case Report ◽

Venous Thrombosis ◽

Laparoscopic Sleeve Gastrectomy ◽

Review Of The Literature ◽

Portomesenteric Venous Thrombosis

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Superior mesenteric venous thrombosis as a first manifestation of Antithrombin III deficiency in the postoperative course of laparoscopic sleeve gastrectomy: a case study of 2 patients from 1211 bariatric patients

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz306 ◽

2019 ◽

Vol 2019 (11) ◽

Author(s):

Vassilis G Giannakoulis ◽

Vasiliki Ntella ◽

Andreas Kiriakopoulos ◽

Maria Kostrova ◽

Evangelos Menenakos

Keyword(s):

Sleeve Gastrectomy ◽

Venous Thrombosis ◽

Laparoscopic Sleeve Gastrectomy ◽

Antithrombin Iii ◽

Splenic Vein ◽

Mesenteric Venous Thrombosis ◽

Vein Thrombosis ◽

Life Threatening ◽

Bariatric Patients ◽

Time Of Presentation

Abstract Superior mesenteric venous thrombosis (SMVT) following laparoscopic sleeve gastrectomy (LSG) is a rare, potentially life-threatening complication, which presents either isolated, or as a part of portal/mesenteric/splenic vein thrombosis. Distinction between them possibly confers an important clinical and prognostic value. Antithrombin III (ATIII) deficiency causes an hypercoagulable state which predisposes to SMVT. We report the clinical presentation and treatment of two patients among 1211 LSGs (incidence = 0.165%) that presented with isolated SMVT and ATIII deficiency in an Academic Bariatric Center. Both patients had an unremarkable past medical history; none was smoker or had a previously known thrombophillic condition/thrombotic episode. Mean time of presentation was 15.5 days after LSG. Despite aggressive resuscitative and anticoagulation measures, surgical intervention was deemed necessary. No mortalities were encountered. Coagulation tests revealed ATIII deficiency in both patients.

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Mesenteric venous thrombosis after laparoscopic sleeve gastrectomy

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2009.08.004 ◽

2010 ◽

Vol 6 (1) ◽

pp. 109-111 ◽

Cited By ~ 26

Author(s):

Drake E. Bellanger ◽

Andrew G. Hargroder ◽

Frank L. Greenway

Keyword(s):

Sleeve Gastrectomy ◽

Venous Thrombosis ◽

Laparoscopic Sleeve Gastrectomy ◽

Mesenteric Venous Thrombosis

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Portomesenteric venous thrombosis after laparoscopic sleeve gastrectomy: A case report and a call for prevention

Journal of Minimal Access Surgery ◽

10.4103/0972-9941.152101 ◽

2015 ◽

Vol 11 (4) ◽

pp. 276 ◽

Cited By ~ 9

Author(s):

SuvirajJ John ◽

Sudhir Kalhan ◽

Vivek Bindal ◽

Parveen Bhatia

Keyword(s):

Sleeve Gastrectomy ◽

Case Report ◽

Venous Thrombosis ◽

Laparoscopic Sleeve Gastrectomy ◽

Portomesenteric Venous Thrombosis

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Acute mesenteric venous thrombosis after laparoscopic sleeve gastrectomy: a case report and a literature review

International Surgery Journal ◽

10.18203/2349-2902.isj20195135 ◽

2019 ◽

Vol 6 (11) ◽

pp. 4124

Author(s):

Alaa Sedik ◽

Fawaz Aleashed ◽

Ahmed Fathi

Keyword(s):

Sleeve Gastrectomy ◽

Venous Thrombosis ◽

Laparoscopic Sleeve Gastrectomy ◽

Superior Mesenteric Vein ◽

Proximal Jejunum ◽

Mesenteric Venous Thrombosis ◽

Mesenteric Vein ◽

Vein Thrombosis ◽

Abdominal Symptoms ◽

High Index Of Suspicion

Over the last decade, laparoscopic sleeve gastrectomy has become an increasingly popular surgical procedure for morbid obesity. Moreover, post-laparoscopic sleeve gastrectomy mesenteric venous thrombosis is very rarely reported. The presentation varies from mild non-speciﬁc abdominal symptoms to life threatening surgical emergency. Superior mesenteric vein thrombosis after bariatric surgery is a difficult diagnosis that needs a high index of suspicion. We report a case of thrombosis of the superior mesenteric vein, who presented as acute emergency to emergency room, shortly after sleeve gastrectomy. Patient underwent laparotomy and offered a resection of 60 cm of infarcted proximal jejunum with restoration of bowel continuity later. Patient subsequently recovered and followed several times in our outpatient and was free of symptoms.

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A systematic review and meta-analysis on endovascular treatment as an attractive alternative for acute superior mesenteric venous thrombosis

Vascular ◽

10.1177/1708538121991270 ◽

2021 ◽

pp. 170853812199127

Author(s):

Lixin Wang ◽

Enci Wang ◽

Fei Liu ◽

Wei Zhang ◽

Xiaolong Shu ◽

...

Keyword(s):

Systematic Review ◽

Treatment Group ◽

Conservative Treatment ◽

Venous Thrombosis ◽

Endovascular Treatment ◽

Meta Analysis ◽

Statistical Significance ◽

Published Data ◽

Mesenteric Venous Thrombosis ◽

Surgery Group

Objective This systematic review and meta-analysis evaluated the published data on the efficacy and safety of therapies for superior mesenteric venous thrombosis (SMVT), aiming to provide a reference and set of recommendations for clinical treatment. Methods Relevant databases were searched for studies published from 2000 to June 2020 on SMVT treated with conservative treatment, surgical treatment, or endovascular approach. Different treatment types were grouped for analysis and comparison, and odds ratios with corresponding 95% confidence intervals were calculated. The outcomes were pooled using meta-analytic methods and presented by forest plots. Results Eighteen articles, including eight on SMVT patients treated with endovascular therapies, were enrolled. The treatment effectiveness was compared between different groups according to the change of symptoms, the occurrence of complications, and mortality as well. The conservative treatment group had better efficacy compared to the surgery group (89.0% vs. 78.6%, P <0.05), and the one-year survival rate was also higher (94.4% vs. 80.0%, P >0.05), but without statistical significance. As for endovascular treatment, the effectiveness was significantly higher than the surgery group (94.8% vs. 75.2%, P <0.05), and the conservative treatment group as well (93.3% vs. 86.3%, P >0.05), which still requires further research for the lack of statistical significance. Conclusions Present findings indicate that anticoagulation, as conservative treatment should be the preferred clinical option in the clinic for SMVT, due to its better curative effect compared to other treatment options, including lower mortality, fewer complications, and better prognosis. Moreover, endovascular treatment is a feasible and promising approach that is worth in-depth research, for it is less invasive than surgery and has relatively better effectiveness, thus can provide an alternative option for SMVT treatment and may be considered as a reliable method in clinical.

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