|
Back to 2016 Annual Meeting
Portomesenteric Thrombosis After Laparoscopic Sleeve Gastrectomy
Toghrul Talishinskiy*, Sebastian Eid, George Mazpule, Richard Novack, Amit Trivedi, Douglas Ewing, Hans Schmidt
Surgery, Hackensack University Medical Center, Hackensack, NJ
INTRODUCTION
Laparoscopic sleeve gastrectomy is currently the most common bariatric surgery at our institution. Portomesenteric vein thrombosis is a relatively uncommon surgical complication with an insidious presentation and a high risk of bowel compromise. The purpose of this study was to present a series of patients who developed postoperative portomesenteric vein thrombosis after sleeve gastrectomy, and to identify the associated risk factors, overall incidence, clinical presentation and management. This is the largest case series presented from North America.
METHODS
This is a retrospective analysis of patients who underwent sleeve gastrectomy and developed portomesenteric vein thrombosis. Demographic data, personal risk factors, clinical presentation, and postoperative results of hypercoagulable work up were analyzed in this study.
RESULTS
A total of 2185 laparoscopic sleeve gastrectomies were performed from August 2011 till August 2015. Twelve patients (0.55%) developed portal vein thrombosis after surgery. Out of these patients seven were women and only two had a remote history of smoking. Mean BMI was 42.7 (range 37 - 49), mean age was 43.1 (range 18 - 53 years). Mean operative time was 67 minutes (range 44 - 90 minutes). Abdominal pain was the most common symptom, presenting at a median of 14 days (range 7 - 178 days) after sleeve gastrectomy. The most common laboratory abnormalities were elevated alkaline phosphatase and lipase. CT with IV contrast was performed in 11 patients, and was diagnostic in all. Due to a severe contrast allergy the twelfth patient had a non-contrast CT which was not diagnostic. Abdominal ultrasound identified portomesenteric thrombosis in this patient, but failed to demonstrate it in three of the other patients. Four patients in the study required additional surgical intervention, including 2 small bowel resections. All patients were treated with anti-coagulation with eventual resolution of symptoms. Six patients had repeat interval imaging, but only two of them were found to have radiographic resolution. Seven patients underwent hypercoagulable work up, revealing an abnormality in five.
CONCLUSIONS
Portal vein and mesenteric thrombosis is a relatively rare but morbid complication in patients undergoing bariatric surgery. Immediate diagnosis and a high index of suspicion is essential for the appropriate care of these patients.
Back to 2016 Annual Meeting
|
