Mesenteric Venous Thrombosis After Laparoscopic Sleeve Gastrectomy: Pathophysiology and Literature Review

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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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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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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