Porto-mesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: Report of 12 Cases

José Salinas, MD, Julio Cerda, MS, Napoleón Salgado, MD, Fernando Pimentel, MD, Andrea Vega, RN, Gustavo Pérez, MD, Alex Escalona, MD, Ricardo Funke, MD, Camilo Boza, MD. Digestive Surgery Department, Hospital Clínico P. Universidad Católica de Chile

 

INTRODUCTION
Laparoscopic Sleeve Gastrectomy (LSG) has gained popularity because it seems to be simpler and safer than Roux-en-Y gastric bypass. Non-cirrhotic non-malignant portal vein thrombosis is a rare disease. However, in our series it has become the most frecuent early complication. The aim of our study is to describe the preoperative patient´s characteristics and clinical presentation of porto-mesenteric thrombosis (PMVT) after LSG.

METHODS AND PROCEDURES
Non concurrent-cohort of patients who underwent LSG at our institution between June 2005 to June 2011 and who had a PMVT.

RESULTS
A total of 1713 LSG cases were performed during that period. Seventeen (1%) patients had a PMVT as a complication. Sixteen (94%) patients were female, with a preoperative age and BMI of 38.1±9.4 years and 35.4±2.04 kg/m2 respectively. Operative time was a median of 75 (40-130) minutes, hospital stay was a median of 3 (2-5) days. All this variables did not differ to the rest of the series. Fifty six percent of the patients were on oral contraceptive, 44% were smokers and 35% had a familiar history of any thrombotic event. All patients received prophylactic low molecular weight heparin during the post-operative hospitalization. Epigastric abdominal pain was the initial symptom in all patients, which occurred between post-operative day 6 and 21 (median 14). CT scan showed thrombosis of the portal vein or one brach in all cases, superior mesenteric vein in 59% and splenic vein in 65%. Thrombophilia screen test was positive in 37.5% of the cases. Postoperative CT scan showed 6 patients with collateral venous flow and 2 patients with portal cavernomatosis.

CONCLUSIONS
PMVT is the main cause of morbidity in our LSG series. Thrombophilia may play an etiologic rol in some cases, however the exact cause is still unknown. We are running several studies to identify the cause and mechanism of this rare complication.


Session Number: SS09 – Obesity Surgery
Program Number: S058

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