Portomesenteric vein thrombosis in sleeve gastrectomy: a 10-year review

Background

Worldwide, the laparoscopic sleeve gastrectomy (LSG) is becoming the dominant bariatric procedure due to its reliable weight loss and low complication rate. Portomesenteric vein thrombosis (PVT) is an uncommon complication of LSG with an incidence of .3% to 1% and can lead to serious consequences, such as bowel ischemia and death.

Objectives

This paper will present the presentation, risk factors, treatment, and long-term outcomes of patients who had PVT post-LSG.

Setting

Five bariatric centers in a private setting in Australia.

Methods

Retrospective data were collected from 5 bariatric centers across Australia from 2007 to 2016.

Results

Across 5 centers, 5951 patients underwent LSG; 18 had recognized PVT (.3%). The mean body mass index was 41.8. Of patients, 39% had a history or family history of deep vein thrombosis. The average time to diagnosis was 13 days (range, 5–25). Treatment was nonoperative with anticoagulation in 94%. One patient required operative management with bowel resection. All patients were discharged on therapeutic anticoagulation. Mean total weight loss was 27.7% (14.8%–66.3%). Mean follow-up was 10 months. There were no mortalities. Given the low number of patients, no statistically significant data could be derived.

Conclusion

PVT is difficult to diagnose, with significant consequences. The presenting symptoms are nonspecific, and a high index of suspicion needs to be maintained. Cross-sectional imaging with computed tomography of the abdomen is recommended. Patients with PVT post-LSG without previous risk factors can be anticoagulated for 3 to 6 months with an international normalized ratio of 2 to 3.