Page 23 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Efficacy of Prophylaxis Protocol in Prevention of Venous

Thromboembolism in Bariatric Surgery Patients

2
1
4
3
Ahmed Hassan , Mohamed Adel , Islam Khaled , Haitham Gbr , Mohamed A Elkerkary 5
AbstrAct
Background: In patients undergoing bariatric surgery, different techniques have been used to avoid venous thromboembolism (VTE),
including pharmacological prophylaxis and mechanical prophylaxis. Our aim was to determine the effectiveness of the prophylaxis procedure
(pharmacological and mechanical prophylaxis) to prevent VTE following bariatric surgery.
Patients and methods: We performed the present cross-sectional study on patients with morbid obesity who were scheduled to undergo
bariatric surgery. The primary outcome of the present stud was the incidence of VTE. The diagnosis of VTE was based on a duplex ultrasound.
Patients were followed up for 1 month after the procedure.
Results: Two patients develop pulmonary embolism (6.1%). The first patient was female aged 40-years-old who underwent a sleeve gastrectomy
2
(SG). Her body mass index (BMI) was 43 kg/m and she had a history of diabetes, hypertension (HTN), and VTE 5 years ago. On the 5th postoperative
day, she complained of shortness of breath and chest pain, which was followed by the diagnosis of pulmonary embolism and ICU admission.
2
The second patient was a female aged 49-years-old who underwent one anastomosis gastric bypass (OAGB) operation. Her BMI was 55 kg/m
and she had a history of diabetes, HTN, and chronic obstructive pulmonary disease (COPD). Twelve days after operation, she complained of
chest pain, palpitations, and shortness of breath, which was followed by the diagnosis of pulmonary embolism and ICU admission.
Conclusion: In conclusion, VTE is associated with an increased risk of morbidity and mortality after bariatric surgery; however, it can be prevented
using an extensive course of thromboprophylaxis. For the best regime in VTE prevention after the bariatric operation, more prospective
experiments are needed.
Keywords: Bariatric surgery, Obesity, Prophylaxis, Venous thromboembolism.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1486

IntroductIon 1–5 Department of Surgery, Faculty of Medicine, Suez Canal University,
Venous thromboembolism (VTE) is considered the most prevalent Ismailia, Egypt
1
cause of postsurgical morbidity and mortality. About 150,000 Corresponding Author: Mohamed A Elkerkary, Department of
individuals die annually from pulmonary embolism (PE) in the Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt,
2
United States, most of them due to deep venous thrombosis (DVT). e-mail: m_kerkary@med.suez.edu.eg
DVT typically has nonspecific symptoms and signs and is usually How to cite this article: Hassan A, Adel M, Khaled I, et al. Efficacy of
3
difficult to detect in patients who are morbidly obese. Physical Prophylaxis Protocol in Prevention of Venous Thromboembolism in
examination is very difficult in obese patients, and they often have Bariatric Surgery Patients. World J Lap Surg 2022;15(1):21–25.
subtle first signs so that minimally symptomatic DVT can quickly Source of support: Nil
progress to fatal PE.
Obesity is an abnormal accumulation of body fat to the Conflict of interest: None
4
extent that it may have a negative effect on health. A strong
12
correlation between obesity and type II diabetes, hypertension evaluate a prophylaxis strategy. Higher age, gender, body mass
(HTN), dyslipidemia, cardiovascular disease, sleep apnea syndrome, index (BMI), immobility, venous stasis disease, operative time, and
5
and several types of cancer is confirmed by long-term research. type and approach of the procedure can be included in these risk
6
Obesity contributes to a deterioration of the quality of life. In both factors.
developed and developing countries, the prevalence of obesity is Obesity also interferes with the mechanisms of anticoagulants,
13
growing rapidly and is considered one of the most severe public leading to a hyper coagulating state. In obese patients, plasma
health issues. 7,8 concentrations of von Willebrand, fibrinogen, and factor VII are
Bariatric surgeries, including sleeve gastrectomy (SG) and substantially elevated, while platelet aggregation due to leptin is
14
gastric bypass surgery (GBS), play a significant and well-established promoted. There is evidence that some of the above abnormalities
9
role in the care of obese and morbidly obese patients. In 2013, the may be partly reversed by the treatment of morbid obesity, as
number of bariatric surgeries alone in the United States was close to weight loss is associated with a substantial decrease in fibrinogen,
10
180,000. Bariatric surgeries are very successful in reducing morbid plasminogen activator inhibitor-1, and an increase in antithrombin
obese patients’ weight and improving obesity and associated III deficiency. 15
11
complications. Accurate, evidence-based risk evaluation methods In patients undergoing bariatric surgery, different techniques
for VTE in bariatric patients are currently not available, but many risk have been used to avoid VTE, including pharmacological prophylaxis
factors that need to be addressed are identified in the literature to and mechanical prophylaxis; pharmacological prophylaxis involves
© The Author(s). 2022 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.