Bariatric Times

JUN 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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25 Journal Watch Bariatric Times • June 2017 n ongastric band surgery, age ≥60 years, male sex, BMI ≥50kg/m 2 , postoperative hospital stay ≥3 days, and operative time ≥3 hours. The model demonstrated good calibration ( Hosmer-Lemeshow goodness-of-fit test, P = 0.71) and discrimination (c- statistic = 0.74). Nearly 2.5 percent of patients had a predicted postdischarge VTE risk >one p ercent. The authors concluded that more than 80 percent of post-bariatric surgery VTE events occurred post- discharge. Congestive heart failure, p araplegia, dyspnea at rest, and reoperation are associated with the highest risk of post-discharge VTE. Routine post-discharge pharmacoprophylaxis can be c onsidered for high-risk patients (ie, VTE risk >0.4%). PMID: 28009739 Prevention of venous t hromboembolism in patients undergoing bariatric surgery. Bartlett MA, Mauck KF, Daniels PR. Vasc Health Risk Manag. 2015;11:461–77. Synopsis: The authors summarize the available evidence after systematic review of the literature regarding approaches to venous thromboembolism (VTE) prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented. PMID: 26316771 Portal vein thrombosis following laparoscopic sleeve gastrectomy: A rare case report. Abu Jkeim N, Al Hazmi A, Alawad AA1, Ibrahim R1, Abudames A, Tawfik S, Mansour M. Int J Case Rep Imag. 2015;6(9):556–559. Synopsis: The authors present the case of a 33-year- old woman who underwent an uncomplicated laparoscopic sleeve gastrectomy for the treatment of morbid obesity, and presented on postoperative day 14 with epigastric pain. Computed tomography revealed left portal vein thrombosis. She promptly improved after initiation of low-molecular weight heparin (LMWH) and was discharged on hospital day five with oral warfarin. They concluded that although uncommon, portal vein thrombosis (PVT) should be included in the differential diagnosis for unexplained abdominal symptoms after laparoscopic sleeve gastrectomy. PMID: 26339157 Portomesenteric venous thrombosis: an early postoperative complication after laparoscopic biliopancreatic diversion. Cesaretti M, Elghadban H, Scopinaro N , Papadia FS. World J Gastroenterol. 2015 ;21(8):2546–2549. Synopsis: The number of bariatric operations, as well as the i ncidence of perioperative complications, has risen sharply in the past 10 years. Perioperative acute portal vein thrombosis is an infrequent and potentially severe p ostoperative complication that has not yet been reported after biliopancreatic diversion (BPD). Here, the authors present three cases of portal vein thrombosis ( PVT) that occurred following BPD treatment for morbid obesity and type 2 diabetes. The thromboses were detected by abdominal ultrasound and computed t omography with intravenous contrast. The portomesenteric venous thromboses in all three cases presented as unexpected abdominal pain several days after discharge f rom the hospital. The complications occurred despite adequate perioperative prophylaxis and progressed to bowel gangrene in the diabetic patients only. They concluded that these cases demonstrate the occurrence of this rare type of complication, which may be observed by physicians that do not routinely treat bariatric patients. Awareness of this surgical complication will allow for early diagnosis and prompt initiation of adequate therapy. PMID: 25741166 Incidence of deep vein thrombosis and thrombosis of the portal-mesenteric axis after laparoscopic sleeve gastrectomy. Alsina E, Ruiz-Tovar J, Alpera MR, Ruiz-García JG, Lopez-Perez ME, Ramon-Sanchez JF, Ardoy F. J Laparoendosc Adv Surg Tech A. 2014;24(9):601-5. Epub 2014 Jul 29. Synopsis: The aim of this prospective observational study was to determine the incidence of deep vein thrombosis (DVT) and portal- splenic-mesenteric vein thrombosis (PSMVT) in the authors' population undergoing laparoscopic sleeve gastrectomy (LSG) as the bariatric technique, with an anti- thromboembolic dosage scheme of 0.5mg/kg/day 12 hours preoperatively and maintained during 30 days postoperatively. The study included 100 consecutive patients undergoing LSG between October 2007 and September 2013. To determine the incidence of DVT and PSMVT, all patients undergo contrast-enhanced abdominal computed tomography (CT) and Doppler ultrasonography (US) of both lower limbs on the third postoperative month, whether they were asymptomatic or symptomatic. Contrast-enhanced CT showed one case of PSMVT (1%). Two patients presented DVT in the right leg (2%). A ll the cases were asymptomatic. The authors concluded that the incidence of PSMVT and DVT after LSG with a prophylactic low- molecular-weight heparin dose of 0 .5mg/kg/day and maintained during 30 days postoperatively is one percent and two percent, respectively. According to these results, a postoperative screening w ith Doppler US and/or contrast- enhanced CT seems to be unnecessary. PMID: 25072524 P ortomesenteric vein thrombosis after laparoscopic sleeve gastrectomy for morbid obesity. Anewenah LS, Asif M, Francesco R, Ramachandra P. BMJ Case Rep. 2 017 Jan 9;2017. Synopsis: The authors present the case of a 34-year-old woman who underwent an uncomplicated laparoscopic sleeve gastrectomy ( LSG) for the treatment of morbid obesity, and presented on postoperative day 13 with Portomesenteric vein thrombosis (PMVT). The patient underwent mechanical thrombectomy and thrombolytic therapy. After two days, patency was restored and the patient was discharged in stable condition. They concluded that a high index of suspicion for PMVT should be considered in patients reporting diffuse abdominal pain a fter LSG. Owing to its lethality, upon confirmation of PMVT, therapy should begin immediately along with extended anticoagulation therapy on discharge. P MID: 28069786 Portal vein thrombosis following laparoscopic sleeve gastrectomy for morbid obesity. R osenberg JM, Tedesco M, Yao DC, Eisenberg D. JSLS. 2012;16(4):639–643. Synopsis: The authors report the case of a man who presented with p ortal vein thrombosis after laparoscopic sleeve gastrectomy. A 41-year-old man underwent an uneventful laparoscopic sleeve gastrectomy for the treatment of m orbid obesity, and presented on postoperative day 10 with nonfocal abdominal pain, nausea, vomiting, and leukocytosis. Computed tomography revealed portal vein t hrombosis, which was found in the setting of Clostridium difficile colitis. They concluded that portal vein thrombosis may be identified with increasing frequency as the number of laparoscopic bariatric operations continues to increase. A high index of suspicion is necessary to diagnose this rare, but potentially lethal, complication. PMID: 23484577

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