Daniela Guevara, MD, Matthew L Dong, MD, MPH, Subhash Kini, MD, Eric Edwards, MD, Daniel Herron, MD, Gustavo Fernandez-Ranvier, MD. Icahn School of Medicine at Mount Sinai
Purpose: Thromboembolic disease is a significant cause of morbidity and mortality in bariatric patients. Controversy exists regarding the optimal prophylactic regimen, balancing prevention of thromboembolic complications and the risk of postoperative hemorrhage. In an effort to reduce our hemorrhagic complications, our group changed its perioperative prophylactic regimen from enoxaparin to subcutaneous heparin. We reviewed our results to determine if this change had a beneficial effect on postoperative hemorrhage in patients undergoing sleeve gastrectomy.
Methods and Procedures: We performed a retrospective review of our prospectively-collected bariatric surgery outcomes database. We identified all patients who experienced postoperative hemorrhage following primary laparoscopic sleeve gastrectomy between January 2011 and August 2016 and reviewed their outcomes.
Results: During the study period, our group performed 1161 primary laparoscopic sleeve gastrectomies. Of these, 18 patients suffered postoperative bleeding (1.6%), of whom 5 required reoperation (0.4%) and the remainder were treated with transfusion alone. There did not appear to be an association between bleeding and choice of chemoprophylaxis. Of note, the rate of postoperative hemorrhage has trended downward since we began using staple line reinforcement, but this difference does not reach statistical significance.
Conclusion: Postoperative hemorrhage is a rare complication of bariatric surgery, but can result in significant morbidity. In our experience the complication is most commonly managed nonoperatively. Further investigation into the choice of chemoprophylaxis and use of staple line reinforcement is warranted.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80249
Program Number: P541
Presentation Session: Poster (Non CME)
Presentation Type: Poster