Outcome of Portal Injuries Following Bariatric Operations |
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Authors: | Sergio Huerta MD Zhaoping Li MD PhD Edward H Livingston MD FACS |
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Institution: | (1) University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, TX, USA;(2) VA Greater Los Angeles System, Los Angeles, CA, USA;(3) University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, TX, USA |
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Abstract: | Background: Portal vein thrombosis is rare following Roux-en-Y gastric bypass (RYGBP). Its natural history is dependent on
the etiology of the thrombosis. Iatrogenic injuries at bariatric operations resulting in portal vein thrombosis are lethal
complications typically necessitating a liver transplant, whereas postoperative portal vein thrombosis without an injury to
the portal vein has a benign course. There are currently no data on management or prognostic factors of portal vein thrombosis
after bariatric operations. Methods: 3 patients referred for liver transplantation secondary to portal vein injury following
bariatric surgery between 2000 and 2003 are presented. Results: 2 super-obese (BMI ≥50 kg/m2) and 1 morbidly obese (BMI 44 kg/m2) patients sustained portal vein injuries during bariatric surgery (RYGBP 2, VBG 1) by experienced bariatric surgeons. In
each case, the portal injury was identified and repaired. Thrombosis followed reconstruction in all 3 patients. All 3 underwent
emergency liver transplantation, but died of sepsis and multi-organ failure following transplantation. Review of the literature
found no cases of traumatic portal vein injuries following bariatric operations and 2 cases of postoperative portal vein thrombosis:
1 following LRYGBP (BMI 46) and one after a Lap-Band (BMI 41). Conclusion: Injury to the portal vein resulting from difficulty
in discerning the anatomy of the intra-abdominal structures in the morbidly obese, is a lethal complication of bariatric surgery.
Super-obese patients submitting to bariatic surgery should lose weight, undergo a two-stage bariatric procedure, or undergo
laparoscopic RYGBP to minimize the risk of portal injury. Postoperative portal vein thrombosis has a benign course and can
be managed conservatively. |
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Keywords: | PORTAL INJURIES MORBID OBESITY GASTRIC BYPASS LETHAL COMPLICATIONS LIVER TRANSPLANTATION |
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