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Portomesenteric Vein Thrombosis Post-Laparoscopic Sleeve Gastrectomy: Case Series and Literature Review

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Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is today one of the leading procedures in bariatric surgery, and portomesenteric vein thrombosis (PMVT) has been reported as one of its rare complications. The purpose of this study is to determine the prevalence, clinical presentation, and outcomes of PMVT in patients undergoing LSG.

Methods

A retrospective study of a database of all post-LSG patients was conducted on the patients who developed PMVT post-LSG from July 2011 to March 2016, at Amiri Hospital, Kuwait.

Results

A total of 2280 patients underwent LSG during the study period. Nine (0.39%) patients were diagnosed with PMVT post-LSG. Diagnosis was confirmed by CT scan for eight patients, and one had urgent laparotomy. The median age was 34 years (20–50), and there were 7 women and 2 men. Median preoperative body mass index (BMI) was 42 kg/m2 (37.5–74.6), and median operative time was 80 min (60–150). The median post-operative anticoagulation duration was 4 days (2–22). The median onset of diagnosis after the surgery was 28 days (18–453), and two patients had a positive thrombophilia study. All patients were treated medically except one patient who underwent urgent laparotomy for small bowel necrosis and eventually had small bowel transplant.

Conclusions

PMVT post-LSG is a rare but possibly dangerous complication. It should be suspected with patients presenting with unresolving abdominal pain. Treatment is mainly conservative and surgical intervention might be needed for small bowel necrosis. Extended anticoagulation prophylaxis is a hypothesis for patients after LSG, and may play a role in preventing PMVT.

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Authors and Affiliations

  1. Department of Surgery, Amiri Hospital, Kuwait Ministry of Health, Kuwait City, Kuwait

    S alman AlSabah, Mohammed AlRuwaished, Sulaiman Almazeedi & Eliana Al Haddad

  2. Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Paris, France

    Elie Chouillard

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  1. S alman AlSabah
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  2. Mohammed AlRuwaished
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Correspondence to S alman AlSabah.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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AlSabah, S.a., AlRuwaished, M., Almazeedi, S. et al. Portomesenteric Vein Thrombosis Post-Laparoscopic Sleeve Gastrectomy: Case Series and Literature Review. OBES SURG 27, 2360–2369 (2017). https://doi.org/10.1007/s11695-017-2637-2

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