PORTOMESENTERIC VEIN THROMBOSIS AFTER SLEEVE GASTRECTOMY: A FIVE-YEAR QUALITY ASSURANCE AND LITERATURE REVIEW
Ryan T. Lenz1, Jaya K. Dhami1,2, Eric Wise1, Daniel Leslie1, Sayeed Ikramuddin1, James V. Harmon*1
1Department of Surgery, University of Minnesota, Minneapolis, MN; 2Oregon Health and Science University, Portland, OR
Background: Portomesenteric vein thrombosis is a rare, potentially life-threatening complication following laparoscopic sleeve gastrectomy. Current quality assurance efforts include identifying patients, analyzing demographics, and patient outcomes. Methods to identify patients with increased risks, optimize prophylaxis, and treat postoperative portomesenteric vein thrombosis remain areas of active research.
Methods: We report one patient referred to our hospital system, four patients identified as a part of our system quality assurance efforts, and 11 patients reported in the literature over the last five years following laparoscopic sleeve gastrectomy.
Results: A total of 16 patients were analyzed. The average patient age was 38 (+/- 11) years; 50% of the patients were female, the average BMI was 41 (+/- 5), and 19% of patients had hepatic cirrhosis. All 16 patients presented with abdominal pain, nausea, and vomiting at an average of 15 (+/- 8) postoperative days, with a range of 6 to 31 days postoperatively. CT scans demonstrated thrombosis in the portal vein (13 patients), splenic vein (7 patients), and superior mesenteric vein (5 patients). Immediate initiation of anticoagulation was associated with 100% survival; however, 13% of patients required segmental bowel resection for ischemia. One patient was identified to have low serum levels of both protein C and antithrombin III. See Table 1 for a separate analysis of the two groups.
Conclusion: Patients with portal mesenteric vein thrombosis following sleeve gastrectomy usually present between 7 and 14 days following laparoscopic sleeve gastrectomy; however, patients may present as early as six days or as late as 30 days postoperatively. Symptoms included upper or generalized abdominal pain associated with nausea and vomiting. CT imaging was diagnostic, and immediate anticoagulation resulted in symptom resolution in 87% of patients without surgical intervention. Evaluation for hypercoagulability identified only one patient with risk factors for postoperative thrombotic complication.
References: Sen et al. Int J Surg Case Rep. 2021 Feb;79:424-427; Frattini et al.Clinical Practice, vol. 16, (2), 2022, pp. 170–173; Amiki et al.Asian J Endosc Surg., 12: 214-217; Lawler et al. Cureus. 2021 Nov 24;13(11):e19872; Chao et al. J Radiol Case Rep. 2018 Mar 31;12(3):10-17; Alshreadah et al. Int J Surg Case Rep. 2018;43:29-31; Alenazi et al. Int J Surg Case Rep. 2019;63:59-64.
Table 1. Patient demographics, characteristics, comorbidity, clinical features, and outcomes from a case report, a five-year quality assessment, and a five-year literature review. Patient demographics, characteristics, comorbidity, clinical features, and outcomes. (SG) Sleeve Gastrectomy
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