Luke Kinsinger, MD, Jessica Smith, MD, Peter Nau, MD, MS, Isaac Samuel, MD. University of Iowa
Background: While several steps forward in venous thromboembolism (VTE) in bariatric procedures have been made, it continues to be the most common fatal complication in this procedure.
Methods: In this study all laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and laparoscopic gastric band insertion patients were retrospectively studied from a prospectively collected cohort. The standard treatment regimen was preoperative weight loss and daily exercise regimen, 5000 IU heparin was administered subcutaneously preoperatively and then every 8 hours postoperatively, mechanical prophylaxis with ambulation within 3 hours of arriving to the bariatric unit and bilateral calf sequential compression devices during the procedure and while in the hospital.
Results: A total of 1087 patients underwent these procedures from January 2008 to September 2015 by 4 different minimally invasive trained surgeons. 4 total VTEs occurred with incidence of 0.37%. 3 VTEs occurred in 818 laparoscopic Roux-en-Y gastric bypass patients with incidence of 0.37% (2 pulmonary emboli and 2 deep venous thromboses). 1 VTE occurred in 233 sleeve gastrectomy patients with incidence of 0.43% (1 deep vein thrombosis). No VTEs were seen in 36 laparoscopic adjustable gastric band insertions. No mortalities were in this group of patients. None of the 4 patients had previous VTEs. 1 patient had a reoperation for leak and the pulmonary embolus was found 1 month post operatively. 1 deep vein thrombosis was found postoperative day 5, and the other was found 3 months postoperatively. The final pulmonary embolus was found 2 months postoperatively.
Conclusion: Maintaining high standards for patients in regard to preoperative weight loss as well as appropriate preoperative exercise regimen and education for early ambulation can reduce risk of VTE occurrence in bariatric procedures.