scholarly journals Prophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy could reduce the frequency of portomesenteric venous thrombosis

2020 ◽  
Vol 102 (9) ◽  
pp. 712-716
Author(s):  
JI Rodríguez ◽  
V Kobus ◽  
I Téllez ◽  
G Pérez
Keyword(s):  
Sleeve Gastrectomy ◽  
Venous Thrombosis ◽  
Hospital Stay ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Bleeding Complications ◽  
Mesenteric Venous Thrombosis ◽  
Post Discharge ◽  
Bleeding Episodes ◽  
Group 2 ◽  
Group 1

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.

scholarly journals 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

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.

scholarly journals A prospective observational study investigating postoperative hemorrhage after laparoscopic sleeve gastrectomy using Bipolar Seal and Cut Caiman® (Aesculap AG)

2021 ◽  
Author(s):  
Clara Boeker ◽  
Frank Brose ◽  
Martina Mall ◽  
Julian Mall ◽  
Christian Reetz ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Hospital Stay ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Revisional Surgery ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Postoperative Hemorrhage ◽  
Bleeding Complications ◽  
Average Hospital ◽  
Vessel Sealing

Introduction  Postoperative hemorrhage (POH) is the second most important acute complication following laparoscopic sleeve gastrectomy (LSG), with staple line leakage being the first. POH is reported in up to 5% of cases after LSG. Sufficient vessel sealing is crucial in avoiding later complications of POH during mobilization. This study investigated bleeding complications after LSG using the Advanced Bipolar Seal and Cut instrument Caiman 5 by Aesculap AG.  Methods  All LSG´s were performed using the Caiman 5 (Aesculap AG). Primary outcome was the incidence of POH, defined as the need for revisional surgery and/or blood transfusions. Secondary outcomes were hemoglobin levels preoperatively at the day of surgery (POD 0) and at postoperative days (POD) 1 and 2, volume and duration of drainage at POD 0-2, procedure time, and length of hospital stay.  Results  100 patients who had undergone LSG from April 2016 to September 2017 were consecutively included in the study. Patients with contraindications to undergo LSG or were not able to give consent were excluded. Four patients needed treatment due to POH, in 3 of them surgery became necessary. Average operation time was 68.5 min, total volume of drainage was 186 ml. The drain stayed in situ for 2.2 days (mean). Average hospital stay was 3.6 days.  Discussion/Conclusion  In our study group of 100 LSG procedures POH was 4%. Operation time, volume and duration of drainage, length of hospital stay were not prolonged. LSG using Caiman is feasible and shows comparable results to other vessel sealing instruments at our center.

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

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. 

scholarly journals Efficacy of Probiotic Saccharomyces boulardii as an Adjuvant Therapy in Acute Childhood Diarrhoea

2017 ◽  
Vol 36 (3) ◽  
pp. 250-255 ◽  
Author(s):  
Dillip Kumar Dash ◽  
Mrutunjaya Dash ◽  
M.D. Mohanty ◽  
Naresh Acharya
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Acute Diarrhoea ◽  
Oral Rehydration Therapy ◽  
Saccharomyces Boulardii ◽  
Care Hospital ◽  
Oral Rehydration ◽  
Group 2 ◽  
A Prospective Study ◽  
Group 1

Introduction: Administration of S. boulardii in addition to rehydration therapy in diarrhea found to be beneficial in many aspects owing to a variety of causes and importantly it is was not associated with any adverse effects.Material and Methods: We conducted a prospective study of children suffering from acute diarrhoea, at a private tertiary care hospital. Children were divided into 2 groups randomly as per odd(Group 1 ) and even (Group 2) bed allotted in indoor at the time of admission: Group 1 included children on oral rehydration therapy (ORT) + Zinc + Saccharomyces boulardii (Probiotic 5 billion CFU twice daily) and Group 2 comprised of children on ORT+ Zinc. Our objective was to systematically review data on the effect of S. boulardii on acute childhood diarrhoea.Results: Out of a total of 126 children less than 2 years, 2-6 years and 6-14 years were 72 (57.14%), 42(33.33%) and 12(09.52%) respectively. The duration of diarrhoea in Group 1 was 26.31 hours and Group 2 was 47.81 hours (p<0.01). The frequency of diarrhoea showed improvement within 24 and 72 hours in Group 1 and Group 2 respectively (p<0.01).Similarly, the mean duration of hospital stay was 2.68 days in Group 1 and 4.8 days in Group 2.The treatment cost was INR 850 and INR 1650 while social cost was INR 1250 and 2600 in Group 1 and 2 respectively.Conclusion:This study shows that S. boulardii reduced the duration, frequency and hospital stay of diarrhoea thereby reducing the treatment and social costs.J Nepal Paediatr Soc 2016;36(3):250-255

scholarly journals Portomesenteric Venous Thrombosis with Bowel Ischemia after Laparoscopic Sleeve Gastrectomy

2019 ◽  
Vol 12 (3) ◽  
pp. 135-137
Author(s):  
Mohamed Abdelmohsen ◽  
Mubarak Alkandari ◽  
Samir Abdulaziz ◽  
Mohamed Alsulimy ◽  
Nagy Ismaeil
Keyword(s):  
Sleeve Gastrectomy ◽  
Venous Thrombosis ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Bowel Ischemia ◽  
Portomesenteric Venous Thrombosis

Abstract 15073: Best Anticoagulation Strategy for Stroke Prophylaxis in Atrial Fibrillation Patients With Amyloidosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sanghamitra Mohanty ◽  
CHINTAN G TRIVEDI ◽  
Joseph Gallinghouse ◽  
Domenico G Della Rocca ◽  
Carola Gianni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Bleeding Complications ◽  
Considerable Proportion ◽  
Medical Procedure ◽  
Bleeding Events ◽  
Full Dose ◽  
Half Dose ◽  
Group 2 ◽  
Group 1

Background: A considerable proportion of elderly patients are known to have coexistent atrial fibrillation (AF) and amyloidosis. Both conditions increase stroke risk. Objective: We evaluated the best anticoagulation strategy in a series of AF patients with amyloidosis. Methods: Consecutive AF patients with coexistent amyloidosis undergoing catheter ablation at our center were included in the analysis. Based on the stroke-prophylaxis approach they were divided into 2 groups; group 1: left atrial appendage occlusion (LAAO) with Watchman and group 2: oral anticoagulation. Following LAAO, all patients remained on full dose non-vitamin K oral anticoagulants (NOAC) for 45 days. Transesophageal echocardiogram (TEE) was performed at 45 days to assess completeness of closure. If the occlusion was complete, patients were kept on aspirin, 81 mg/day for long-term. In case of leak or dense ‘smoke’ in the left atrium (LA) or enlarged LA, they were prescribed half-dose NOAC. NOACs included dabigatran, apixaban, endoxaban and rivaroxaban. Group 2 patients remained on full-dose NOAC during the whole study period (1 year). All patients were prospectively followed up for 1 year. Results: A total of 87 patients were included in the analysis; group 1: 56 and group 2: 31 . CHA 2 DS 2 -VASc score was comparable between the groups (gr. 1: 3.7±1.6 and gr. 2: 3.2±1.7, p=0.18). The most commonly used NOACs were apixaban (45, 51.7%) and rivaroxaban (34, 39%). After the 45-day TEE, 34 patients from group 1 remained on baby-aspirin and 22 on half-dose NOAC. Of the 22, 12 patients had leaks <5 mm, 6 had large LA (mean diameter 5.2±1.4 cm) and 4 patients had dense LA smoke. At 1-year follow-up, 3 stroke and 1 transient ischemic attack were reported in group 1 on baby-aspirin (4/34, 11.8%). No stroke or bleeding complications occurred in the 22 patients on half-dose NOAC. In group 2 patients on full-dose OAC, a total of 5 (5/31, 16.1%) bleeding events (1 subdural hematoma and 4 GI bleedings) were recorded. Additionally, a stroke was reported that happened during brief discontinuation of OAC for another medical procedure. Conclusion: In our series of patients with coexistent AF and amyloidosis, half-dose NOAC following LAA occlusion procedure was observed to be the safest stroke-prophylaxis strategy.

scholarly journals Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial

2010 ◽  
Vol 162 (4) ◽  
pp. 661-666 ◽  
Author(s):  
Zhi-gang Mao ◽  
Yong-hong Zhu ◽  
Hai-liang Tang ◽  
Dao-yuan Wang ◽  
Jing Zhou ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Transsphenoidal Surgery ◽  
Randomised Trial ◽  
Preoperative Treatment ◽  
Surgical Morbidity ◽  
Randomised Study ◽  
Surgical Cure ◽  
Group 2 ◽  
Cure Rates ◽  
Group 1

ObjectiveTo investigate whether 4-month preoperative lanreotide treatment would improve the surgical cure rate of newly diagnosed acromegalic patients with macroadenomas.DesignA prospective, randomised study.MethodsAfter a baseline evaluation, patients were randomly assigned to 4-month preoperative treatment with lanreotide (starting with 30 mg/2 weeks i.m. and increasing to 30 mg/week i.m. at week 8 if mean GH >2.5 μg/l on GH day curves; pretreatment group, Group 1) or to transsphenoidal surgery (direct surgery group, Group 2). Cure was evaluated 4 months postoperatively primarily by fasting IGF1 less than or equal to age-adjusted upper limit of normal.ResultsA pool of 108 patients was randomly divided into two groups. Five patients in each group were lost to follow-up during the study period, so 49 patients in each group were analysed. At baseline, no difference was observed between the two groups. Cure was established in 24 of 49 (49.0%, 95% confidence interval (CI), 35.0–63.0%) pretreated patients (Group 1) versus 9 of 49 (18.4%, 95% CI, 7.6–29.2%) direct surgery patients (Group 2;P=0.001). Surgical morbidity was recorded in 12 patients (12.2%) and was similar in Group 1 and 2 patients (14.3 and 10.2% respectively;P=0.538). The postoperative hospital stay was similar between groups: being 4.5±1.6 days in Group 1 vs 4.8±1.9 days in Group 2 (P=0.328).ConclusionsPretreatment with lanreotide before transsphenoidal surgery improves surgical cure rates in patients with GH-secreting pituitary macroadenomas. Pretreatment does not affect surgical complications or duration of hospital stay (ClinicalTrials.gov number, NCT00993356).

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