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Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy

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Abstract

Introduction

Portal and mesenteric vein thrombosis are relatively uncommon surgical complications, with difficult diagnosis and potentially severe consequences due to higher risk of bowel infarction. The purpose of this study was to present a series of patients who developed postoperative portal vein thrombosis after laparoscopic sleeve gastrectomy.

Methods

This is a retrospective analysis of patients who underwent sleeve gastrectomy between June 2005 and June 2011 who developed portal vein thrombosis. Demographic data, personal risk factors, family history of thrombosis, and postoperative results of thrombophilia study were analyzed in this study.

Results

A total of 1,713 laparoscopic sleeve gastrectomies were performed. Seventeen patients (1 %) developed portal vein thrombosis after surgery. Of the 17 patients, 16 were women, 8 had a history of smoking, 7 used oral contraceptives, and 2 had a family history of deep vein thrombosis of the lower limbs. All patients were discharged on the third day of surgery with no immediate complications. Symptoms presented at a median of 15 (range, 8–43) days after surgery with abdominal pain in most cases. One case required emergency laparotomy and splenectomy because of an active bleeding hematoma with massive portomesenteric vein thrombosis. In 11 cases, a thrombosis of the main portal vein was identified, in 15 the right portal branch was compromised, and in 10 the left portal branch. Eleven patients presented thrombosis of the superior mesenteric vein, and ten patients presented a concomitant thrombosis of the splenic vein. A massive PMVT was presented in six cases. Seven patients had a positive thrombophilia study.

Conclusions

Portal vein thrombosis and/or mesenteric thrombosis are relatively uncommon complications in patients undergoing bariatric surgery. In this series, the portomesenteric vein thrombosis was the most common complication after LSG in a high-volume center.

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Disclosures

Drs. Salinas, Barros, Salgado, Viscido, Funke, Pérez, Pimentel, and Boza have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Surgery Division, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Santiago, Chile

    José Salinas, Diego Barros, Napoleón Salgado, Germán Viscido, Ricardo Funke, Gustavo Pérez, Fernando Pimentel & Camilo Boza

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  1. José Salinas
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  2. Diego Barros
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  3. Napoleón Salgado
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Correspondence to Camilo Boza.

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Salinas, J., Barros, D., Salgado, N. et al. Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy. Surg Endosc 28, 1083–1089 (2014). https://doi.org/10.1007/s00464-013-3055-8

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  • DOI: https://doi.org/10.1007/s00464-013-3055-8

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