Laparoskopik Sleeve Gastrektomi Sonrası Portomezenterik Venöz Tromboembolinin Non-Operatif Yönetimi ve Uzun Dönem Anti Koagülan Proflaksinin Önemi

Year 2021, , 19 - 24, 24.04.2021

Server Sezgin Uludağ

https://doi.org/10.25048/tudod.839934

Abstract

Amaç: Portomezenterik ven trombozu (PMVT), Laparoskopik sleeve gastrektominin (LSG) nadir ve potansiyel olarak hayatı tehdit eden bir komplikasyonudur. Etkin antikoagülan proflaksisi ile çoğu zaman tedaviye olumlu yanıt alınmaktadır. LSG sonrası PMVT gelişen hastaların insidans, klinik özellikler, takip ve tedavisini irdelemeyi amaçladık.
Yöntemler: 2010 - 2019 yılları arasında obezite nedeniyle LSG uygulanan 683 hasta retrospektif olarak tarandı. Tüm hastalarda tanı, abdominal bilgisayarlı tomografi (BT) taraması ile konuldu. Tüm hastaların yaş, cinsiyet, vücut kitle indeksi (BMİ), tromboz risk faktörleri, ameliyat verileri, PMVT klinik özellikleri, tanı ,takip ve tedavi bulguları ve görüntüleme verileri analiz edildi.
Bulgular: Toplam 683 hastaya LSG uygulandı ve 4 hastada (%0,58) PMVT gelişti. Tüm hastaların yaş ortalaması 36.25±6.89 (29-45) yıl, 3 hasta kadındı. Ortalama BMİ 36.42±0,95 (35,1-37,3) kg/m2 idi. 3 hastada sigara öyküsü vardı. Tüm hastalara antikoagülan tedavi uygulandı ve Konservatif tedaviye yanıt alındı. Ortalama yatış süresi 2.75±0.5 gün (2-3). İkinci yatış süreleri ortalama 8.75 gün (5-8 gün) idi. Bir hastada protein c eksikliği tanısı konuldu. Herhangi mortalite veya morbidite izlenmedi.
Sonuçlar: PMVT, bariatrik cerrahiyi takiben gelişen nadir fakat ciddi bir komplikasyondur. Konservatif tedavi esastır. Alta yatan nedene yönelik tedavi mutlaka gerektirmektedir. İnce bağırsak nekrozu için cerrahi müdahale şarttır. Uzun dönem antikoagülan profilaksisi LSG sonrası hastalar için PMVT'nin önlenmesinde ve PMVT gelişmesi durumunda iyi prognozlu seyretmesinde rol alabilmektedir. PMVT'nin uzun dönem hasta sonuçları üzerindeki etkisini değerlendirmek amacıyla daha uzun süreli takiple ve daha fazla hasta popülasyonu ihtiyaç vardır.

Keywords

Laparoskopik sleeve gastrektomi, Portomezenterik ven trombozu, Antikoagülan

The Non-Operative Management of Portomesenteric Venous Thromboembolism After Laparoscopic Sleeve Gastrectomy and the Importance of Long-Term Anticoagulant Prophylaxis, A University Hospital Experience

Abstract

Aim: Portomesenteric venous thrombosis (PMVT) is a rare and life-threatening complication of laparoscopic sleeve gastrectomy (LSG). Treatment is usually established with proper anticoagulant prophylaxis. In this study, we aimed to focus on the incidence, clinical characteristics, follow-up, and treatment of patients who have undergone LSG procedures and developed PMVT.

Material and Methods: Between the years of 2010 – 2019, we retrospectively screened 683 patients who had undergone LSG operation due to obesity. In all patients, the diagnosis was established with abdominal computerized tomography (CT). Age, gender, body mass index (BMI), thrombosis risk factors, surgical details, PMVT clinical characteristics, follow-up, and treatment features were analyzed in patients diagnosed with PMVT.

Results: LSG was performed on 683 patients and four patients (0.58%) developed PMVT. The average age of patients was 36.25±6.89 (29-45) years and only three patients were female. The average BMI was 36.42±0.95 (35.1-37.3) kg/m2. Three patients had a smoking history. All patients received anticoagulant therapy and responded to conservative treatment. The average length of stay in the hospital
was 2.75±0.5 days (2-3). The average length of stay on the second admission to the hospital was 8.75 days (5-8 days). One patient had the diagnosis of protein C deficiency. No mortality or morbidity was observed.

Conclusion: PMVT is a rare but serious complication following bariatric surgery. Conservative treatment is fundamental. Treatment is required based on any underlying disease if present. Surgical intervention is required for small bowel necrosis. The findings of our study support the information that long-term anticoagulant prophylaxis plays a role in preventing PMVT after LSG, as well as improving
prognosis on patients who have already developed PMVT. To evaluate the long-term effects of PMVT on patients, a longer time of follow-up and a larger patient population is needed.

Keywords

Laparoscopic sleeve gastrectomy, Portomesenteric venous thrombosis, Anticoagulant

References

• 1. Karaman K, Aziret M, Bal A, Öter V, Ercan M, Bostancı EB. Porto-mesenteric venous thrombosis after laparoscopic sleeve gastrectomy: A case report and systematic review of the 104 cases. Obes Res Clin Pract. 2018;12(3):317-325.
• 2. Shaheen O, Siejka J, Thatigotla B, Pham DT. A systematic review of portomesenteric vein thrombosis after sleeve gastrectomy. Surg Obes Relat Dis. 2017;13(8):1422-1431.
• 3. Miller K. Obesity: surgical options. Best Pract Res Clin Gastroenterol. 2004;18(6):1147-1165.
• 4. Kocaöz S, Yılmaz A, Gemcioğlu E, Parlak Ö. Obezite cerrahisi sonrası semptomatik kolelitiazis gelişme sıklığı ve cerrahi tedavide zamanlama. Turk J Diab Obes. 2020;4(3):244-248.
• 5. Seyit H. Laparoskopik sleeve gastrektominin kan basıncı üzerine erken dönem etkisi. Turk J Diab Obes. 2020;4(1):7-10
• 6. WHO | Overweight and obesity. (Accessed March 11, 2021, at https://www.who.int/gho/ncd/risk_factors/overweight_text/ en/. (Accessed: 19-May-2020).
• 7. Zilberstein B, Santo MA, Carvalho MH. Critical analysis of surgical treatment techniques of morbid obesity. Arq Bras Cir Dig. 2019;32(3):e1450.
• 8. Muneer M, Abdelrahman H, El-Menyar A, Zarour A, Awad A, Al Dhaheri M, Al-Thani H. Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy: 3 case reports and a literature review. Am J Case Rep. 2016;17:241-247.
• 9. Caruso F, Cesana G, Lomaglio L, Cioffi S, Ciccarese F, Uccelli M, Olmi S. Is portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy related to short-course prophylaxis of thromboembolism? A monocentric retrospective analysis about an infrequent but not rare complication and review of the literature. J Laparoendosc Adv Surg Tech A. 2017;27(10):987- 996.
• 10. Bucheeri MM, Abulsel AY. Case series: Portomesenteric venous thrombosis complicating laparoscopic bariatric procedures. Int J Surg Case Rep. 2019;62:126-131.
• 11. Almarshad FM, Almegren M, Alshuaibi T, Alobaodi N, Almutawa A, Basunbl H, AlGahtani F, Al Rawahi B. Thromboprophylaxis after bariatric surgery. Blood Res. 2020;55(1):44-48.
• 12. Bartlett MA, Mauck KF, Daniels PR. Prevention of venous thromboembolism in patients undergoing bariatric surgery. Vasc Health Risk Manag. 2015;11:461-477.
• 13. Godoroja D, Hainarosie D, Zaharencu A, Copaescu C. Portal Vein thrombosis a rare but life-threatening complication after laparoscopic sleeve gastrectomy: A 5 years study in a bariatric center of excellence. Chirurgia (Bucur). 2019;114(6):711-724.
• 14. Alenazi NA, Ahmad KS, Essa MS, Alrushdan MS, Al-Shoaibi AM. Porto-mesenteric vein thrombosis following laparoscopic sleeve gastrectomy for morbid obesity: Case series and literature review. Int J Surg Case Rep. 2019;63:59-64
• 15. Bani Hani MN, Al Manasra ARA, Obeidat F, Al-Omari MH, Bani Hani F. Portomesenteric venous thrombosis postlaparoscopic sleeve gastrectomy: Do energy systems pose as instigating factor to this infrequent complication? Clin Med Insights Case Rep. 2019;12:1179547619843503
• 16. Alshreadah S, Alotaibi R, Aldabaeab A, Alhafid I. Thrombosis of the spleno-mesentiric portal axis following laparoscopic sleeve gastrectomy: A rare case report. Int J Surg Case Rep. 2018;43:29-31.
• 17. Danion J, Genser L, Scatton O. Sleeve gastrectomy: You might lose your liver! Obes Surg. 2019;29(1):350-352.
• 18. Shoar S, Saber AA, Rubenstein R, Safari S, Brethauer SA, Al- Thani H, Asarian AP, Aminian A. Portomesentric and splenic vein thrombosis (PMSVT) after bariatric surgery: A systematic review of 110 patients. Surg Obes Relat Dis. 2018;14(1):47-59.
• 19. Tan SBM, Greenslade J, Martin D, Talbot M, Loi K, Hopkins G. Portomesenteric vein thrombosis in sleeve gastrectomy: A 10-year review. Surg Obes Relat Dis. 2018;14(3):271-27.5
• 20. Berthet B, Bollon E, Valero R, Ouaissi M, Sielezneff I, Sastre B. Portal vein thrombosis due to factor 2 leiden in the postoperative course of a laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2009;19(10):1464-1467.
• 21. Karagöz Eren S, Çınar O, Yalı A, Çarkıt S, Topuz Ö, Ertan, T. Portomesenteric and splenic vein thrombosis after laparoscopic sleeve gastrectomy. Laparosc Endosc Surg Sci. 2018;25(3):117-120.
• 22. Amitrano L, Guardascione MA, Scaglione M, Pezzullo L, Sangiuliano N, Armellino MF, Manguso F, Margaglione M, Ames PRJ, Iannaccone L, Grandone E, Romano L, Balzano A. Prognostic factors in noncirrhotic patients with splanchnic vein thromboses. Am J Gastroenterol. 2007;102(11):2464-70.