Page 24 - World Journal of Laparoscopic Surgery

Laparoscopic OAGB, Laparoscopic SG, and VTE
low-molecular-weight heparin (LMWH), and mechanical prophylaxis the association between baseline data and outcomes, we used
includes intermittent compression devices, elastic stockings, and Chi-square or Fisher’s exact tests (for categorical) and t-test (for
early ambulation after surgery. 16,17 Our aim was to determine the numerical data) depending on data normality. All statistical analyzes
effectiveness of the prophylaxis procedure (pharmacological and were performed using the SPSS (version 22 for Windows, IBM,
mechanical prophylaxis) to prevent VTE following bariatric surgery. Armonk, New York). A two-sided p-values <0.05 were considered
Moreover, to demonstrate that the regimen of prophylaxis played statistically significant.
a significant role in preventing VTE following bariatric surgery.
results
PAtIents And Methods Baseline Characteristics
Study Design and Patients A total of 33 patients were included with a mean age of
We performed the present cross-sectional study at the Department 32.6 ± 6.1 years and female predominance (66.7%). Our patients
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of Surgery, Faculty of Medicine, Suez Canal University from January had a mean BMI of 47 ± 5.9 kg/m . All patients had hyperlipidemia
2019 to February 2020. Patients aged more than 16-years-old (100%), 66.6% had diabetes mellitus, and 51.5% had hypertension.
were deemed eligible if they had documented morbid obesity, Besides, 12.2% of the patients had a previous history of DVT. Most
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defined as BMI ≥40 kg/m or ≥35 kg/m with comorbidities, of the patients did laparoscopic sleeve gastrectomy (LSG) operation
and were scheduled to undergo bariatric surgery. Patients were (81.8%) and 18.2% did one anastomosis gastric bypass (OAGB).
excluded if they aged more than 65-years-old, had documented Concerning the risk factors for VTE, 33.3% of patients were smokers,
coronary artery disease, malignancy, chronic hepatic or renal 30.3% had varicose vein, 27.3% on contraceptive therapy, 9.1% did
impairments, mental or cognitive illness, history of VTE, history of major surgery in the last 3 months, 12.1% had previous DVT, and
heparin-induced thrombocytopenia, coagulation defects, and/or 6.1% had previous CVS disease (Table 1).
history of concomitant anticoagulant/antiplatelet therapy for other
risk factors. We excluded pregnant women as well. Operative and Postoperative Characteristics
Our protocol was approved by the institutional review board The mean operative time was 71.67 ± 23.61 minutes; OAGB
at Suez Canal University and all participants signed informed operation had a significantly longer mean operative duration
written consent before the procedure. of 120.0 ± 9.49 minutes than SG operation 60.93 ± 3.11 minute

Sampling Table 1: Preoperative characteristics
The required sample size was calculated based on the following Variables (N = 33)
equation. Age (Mean ± SD) 32.6 ± 6.1
 ∝  Z 2 Range (23–55)
P
n =  /2  * (1− P ) Gender
 E

Male 11 33.3
where n = required sample size; Z (∝/2) = 1.96; P = prevalence of the Female 22 66.7
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outcome (estimated to be 2%); and E = margin of error determined BMI (Mean ± SD) 47 ± 5.9
to be 0.05. Range (38–60)
Thus, the calculated sample size was 30 participants. By Comorbidities N %
calculating the nonresponse rate which is 10% based on previous Hypertension 17 51.5
studies, the required sample size was 33 participants. Diabetes mellitus 21 66.6
Data Collection and Prophylaxis Protocol Dyslipidemia 33 100
We collected the following routine preoperative characteristics of Previous history of VTE 4 12.2
the patients: demographics, BMI, comorbidities, and risk factors for Heart failure 0 0
VTE. Besides, we collected the type of procedure, operative time, COPD 2 6.1
postoperative complications, hospital stay, and the incidence of Operation type N %
VTE. The VTE prophylaxis protocol in our institution consists of Sleeve 27 81.8
mechanical modalities (such as lower extremity compression and Mini gastric bypass 6 18.2
early mobilization) and pharmacological modalities in the form of Roux-en-Y operation 0 0
Enoxaparin 40 mg once daily the day before surgery (preoperative) Others 0 0
and continued 15 days after the procedure.
Risk factors for DVT
Outcome Measures Varicose vein 10 30.3
The primary outcome of the present stud was the incidence of VTE. Previous DVT 4 12.1
The diagnosis of VTE clinically was based on painful, tender calf Previous pulmonary embolism 0 0
muscles, sudden shortness of breath, chest pain, and cough and Major surgery in last 3 months 3 9.1
radiologically by duplex ultrasound and CT chest angiography if Previous MI 0 0
needed. Patients were followed up for 1 month after the procedure. Previous CVS disease 2 6.1
Statistical Analysis Smoking 11 33.3
For descriptive statistics, we used the mean ± standard deviation, Heart failure 0 0
while for categorical parameters, we used the count (%). To analyze Contraceptive therapy 9 27.3

22 World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022)