Skip to main content
Erschienen in: International Journal of Colorectal Disease 6/2011

01.06.2011 | Original Article

Prolonged use of thromboprophylaxis may not be necessary in laparoscopic colorectal surgery

verfasst von: Paulus Menno Verheijen, Andrew R. L. Stevenson, Russel W. Stitz, David A. Clark, Andrew J. Clark, John W. Lumley

Erschienen in: International Journal of Colorectal Disease | Ausgabe 6/2011

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Patients undergoing colorectal resections are considered high risk for developing thromboembolic disease. We postulate, however, that the rapid recovery and swift mobilization after laparoscopic resections reduce this risk and that these patients therefore do not need prolonged thromboprophylaxis. This hypothesis was tested in this paper.

Methods

All patients who underwent laparoscopic colorectal surgery in our Colorectal Surgical Unit in the period from June 1991 until January 2010 were entered into a prospective database. The entire database was reviewed, and incidence of thromboembolic disease and significant bleeding complications were noted.

Results

Three thousand, three hundred sixty-four patients were laparoscopically operated on for colorectal disease and were entered in the database. Two thousand, one hundred twenty-seven patients were operated on for benign disease; 1,230, for colorectal cancer, and four, for other malignancies. Two deep venous thromboses were encountered (0.059%), and ten patients had pulmonary embolism (0.30%). The combined venous thromboembolism (VTE) risk for the overall group of patients undergoing laparoscopic colorectal operations is 0.36%. The combined VTE risk was 0.57% (7/1,230) in patients with colorectal cancer and 0.24% (5/2,127) in patients with benign disease (p = 0.118). Bleeding complications occurred in 44 patients (1.3%).

Conclusions

In our group, the combined VTE risk for the overall group of patients undergoing laparoscopic colorectal operations is 0.36%. Therefore, we postulate that the prolonged use of thromboprophylaxis is not indicated in the vast majority of patients undergoing laparoscopic colorectal surgery. In particular, patients undergoing laparoscopic resections for benign disease and without other risk factors have such a low VTE risk that prolonged prophylaxis is probably not warranted.
Literatur
1.
Zurück zum Zitat Hull RD, Brant RF, Pineo GF, Stein PD, Raskob GE, Valentine KA (1999) Arch. preoperative vs postoperative initiation of low-molecular-weight heparin prophylaxis against venous thromboembolism in patients undergoing elective hip replacement. Intern Med 159(2):137–141 Hull RD, Brant RF, Pineo GF, Stein PD, Raskob GE, Valentine KA (1999) Arch. preoperative vs postoperative initiation of low-molecular-weight heparin prophylaxis against venous thromboembolism in patients undergoing elective hip replacement. Intern Med 159(2):137–141
2.
Zurück zum Zitat Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:381SPubMedCrossRef Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:381SPubMedCrossRef
3.
Zurück zum Zitat Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG (2004) Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126(3 Suppl):338S–400SPubMedCrossRef Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG (2004) Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126(3 Suppl):338S–400SPubMedCrossRef
4.
Zurück zum Zitat Francis CW, Pellegrini VD Jr, Totterman S, Boyd AD Jr, Marder VJ, Liebert KM, Stulberg BN, Ayers DC, Rosenberg A, Kessler C, Johanson NA (1997) Prevention of deep-vein thrombosis after total hip arthroplasty. Comparison of warfarin and dalteparin. J Bone Joint Surg Am 79(9):1365–1372PubMed Francis CW, Pellegrini VD Jr, Totterman S, Boyd AD Jr, Marder VJ, Liebert KM, Stulberg BN, Ayers DC, Rosenberg A, Kessler C, Johanson NA (1997) Prevention of deep-vein thrombosis after total hip arthroplasty. Comparison of warfarin and dalteparin. J Bone Joint Surg Am 79(9):1365–1372PubMed
5.
Zurück zum Zitat Hull RD, Pineo GF, Stein PD, Mah AF, MacIsaac SM, Dahl OE, Ghali WA, Butcher MS, Brant RF, Bergqvist D, Hamulyak K, Francis CW, Marder VJ, Raskob GE (2001) Timing of initial administration of low-molecular-weight heparin prophylaxis against deep vein thrombosis in patients following elective hip arthroplasty: a systematic review. Arch Intern Med 161(16):1952–1960PubMedCrossRef Hull RD, Pineo GF, Stein PD, Mah AF, MacIsaac SM, Dahl OE, Ghali WA, Butcher MS, Brant RF, Bergqvist D, Hamulyak K, Francis CW, Marder VJ, Raskob GE (2001) Timing of initial administration of low-molecular-weight heparin prophylaxis against deep vein thrombosis in patients following elective hip arthroplasty: a systematic review. Arch Intern Med 161(16):1952–1960PubMedCrossRef
6.
Zurück zum Zitat Raskob GE, Hirsh J (2003) Controversies in timing of the first dose of anticoagulant prophylaxis against venous thromboembolism after major orthopedic surgery. Chest 124(6 Suppl):379S–385SPubMedCrossRef Raskob GE, Hirsh J (2003) Controversies in timing of the first dose of anticoagulant prophylaxis against venous thromboembolism after major orthopedic surgery. Chest 124(6 Suppl):379S–385SPubMedCrossRef
7.
Zurück zum Zitat Rasmussen MS, Jørgensen LN, Wille-Jørgensen P (2009) Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev (1): CD004318 Rasmussen MS, Jørgensen LN, Wille-Jørgensen P (2009) Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev (1): CD004318
8.
Zurück zum Zitat Borly L, Wille-Jørgensen P, Rasmussen MS (2005) Systematic review of thromboprophylaxis in colorectal surgery—an update. Colorectal Dis 7(2):122–127PubMedCrossRef Borly L, Wille-Jørgensen P, Rasmussen MS (2005) Systematic review of thromboprophylaxis in colorectal surgery—an update. Colorectal Dis 7(2):122–127PubMedCrossRef
9.
Zurück zum Zitat Wille-Jørgensen P, Rasmussen MS, Andersen BR, Borly L (2003) Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database Syst Rev (4):CD001217 Wille-Jørgensen P, Rasmussen MS, Andersen BR, Borly L (2003) Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database Syst Rev (4):CD001217
10.
Zurück zum Zitat Cheung HY, Chung CC, Yau KK, Siu WT, Wong SK, Chiu E, Li MK (2008) Risk of deep vein thrombosis following laparoscopic rectosigmoid cancer resection in Chinese patients. Asian J Surg 31(2):63–68PubMedCrossRef Cheung HY, Chung CC, Yau KK, Siu WT, Wong SK, Chiu E, Li MK (2008) Risk of deep vein thrombosis following laparoscopic rectosigmoid cancer resection in Chinese patients. Asian J Surg 31(2):63–68PubMedCrossRef
11.
Zurück zum Zitat Richardson WS, Apelgren K, Fanelli RD, Earle D (2007) Deep venous thrombosis prophylaxis in laparoscopy: an evidence-based review. Surg Endosc 21(12):2335–2338, Epub 2007 Oct 18PubMedCrossRef Richardson WS, Apelgren K, Fanelli RD, Earle D (2007) Deep venous thrombosis prophylaxis in laparoscopy: an evidence-based review. Surg Endosc 21(12):2335–2338, Epub 2007 Oct 18PubMedCrossRef
12.
Zurück zum Zitat Nguyen NT, Hinojosa MW, Fayad C, Varela E, Konyalian V, Stamos MJ, Wilson SE (2007) Laparoscopic surgery is associated with a lower incidence of venous thromboembolism compared with open surgery. Ann Surg 246(6):1021–1027PubMedCrossRef Nguyen NT, Hinojosa MW, Fayad C, Varela E, Konyalian V, Stamos MJ, Wilson SE (2007) Laparoscopic surgery is associated with a lower incidence of venous thromboembolism compared with open surgery. Ann Surg 246(6):1021–1027PubMedCrossRef
13.
Zurück zum Zitat Anderson FA, Spencer FA (2003) Risk factors for venous thromboembolism. Circulation 107(Suppl 1):I9–I16PubMed Anderson FA, Spencer FA (2003) Risk factors for venous thromboembolism. Circulation 107(Suppl 1):I9–I16PubMed
14.
Zurück zum Zitat Nguyen NT, Cronan M, Braley S, Rivers R, Wolfe BM (2003) Duplex ultrasound assessment of femoral venous flow during laparoscopic and open gastric bypass. Surg Endosc 17(2):285–290PubMedCrossRef Nguyen NT, Cronan M, Braley S, Rivers R, Wolfe BM (2003) Duplex ultrasound assessment of femoral venous flow during laparoscopic and open gastric bypass. Surg Endosc 17(2):285–290PubMedCrossRef
15.
Zurück zum Zitat Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726PubMedCrossRef Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726PubMedCrossRef
16.
Zurück zum Zitat Lindberg F, Bergqvist D, Rasmussen I (1997) Incidence of thromboembolic complications after laparoscopic cholecystectomy: review of the literature. Surg Laparosc Endosc 7(4):324–331PubMedCrossRef Lindberg F, Bergqvist D, Rasmussen I (1997) Incidence of thromboembolic complications after laparoscopic cholecystectomy: review of the literature. Surg Laparosc Endosc 7(4):324–331PubMedCrossRef
17.
Zurück zum Zitat Huber O, Bounameaux H, Borst F, Rohner A (1992) Postoperative pulmonary embolism after hospital discharge. An underestimated risk. Arch Surg 127:310–313PubMed Huber O, Bounameaux H, Borst F, Rohner A (1992) Postoperative pulmonary embolism after hospital discharge. An underestimated risk. Arch Surg 127:310–313PubMed
18.
Zurück zum Zitat Lausen I, Jensen R, Jorgensen LN et al (1998) Incidence and prevention of deep venous thrombosis occurring late after general surgery: randomized controlled study of prolonged thromboprophylaxis. Eur J Surg 164:657–663PubMedCrossRef Lausen I, Jensen R, Jorgensen LN et al (1998) Incidence and prevention of deep venous thrombosis occurring late after general surgery: randomized controlled study of prolonged thromboprophylaxis. Eur J Surg 164:657–663PubMedCrossRef
19.
Zurück zum Zitat Bergqvist D, Angelli G, Cohen A et al (2002) Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 346:975–980PubMedCrossRef Bergqvist D, Angelli G, Cohen A et al (2002) Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 346:975–980PubMedCrossRef
20.
Zurück zum Zitat National Institute for Health and Clinical Excellence (2010) Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. NICE clinical guideline no. 46:1–160. http://www.nice.org.uk/CG046. Accessed September 28, 2008 National Institute for Health and Clinical Excellence (2010) Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. NICE clinical guideline no. 46:1–160. http://​www.​nice.​org.​uk/​CG046. Accessed September 28, 2008
21.
Zurück zum Zitat White RH, Zhou H, Romano PS (2003) Incidence of symptomatic venous thromboembolism after elective or urgent surgical procedures. Thromb Haemost 90:446–455PubMed White RH, Zhou H, Romano PS (2003) Incidence of symptomatic venous thromboembolism after elective or urgent surgical procedures. Thromb Haemost 90:446–455PubMed
Metadaten
Titel
Prolonged use of thromboprophylaxis may not be necessary in laparoscopic colorectal surgery
verfasst von
Paulus Menno Verheijen
Andrew R. L. Stevenson
Russel W. Stitz
David A. Clark
Andrew J. Clark
John W. Lumley
Publikationsdatum
01.06.2011
Verlag
Springer-Verlag
Erschienen in
International Journal of Colorectal Disease / Ausgabe 6/2011
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-011-1139-2

Weitere Artikel der Ausgabe 6/2011

International Journal of Colorectal Disease 6/2011 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.