Page 25 - World Journal of Laparoscopic Surgery

Laparoscopic OAGB, Laparoscopic SG, and VTE
Table 2: Operative data of surgeries complications, rates of VTE incidents after bariatric surgery
(N = 33) range from 0.3 to 2.2%. The optimal dose or duration of throm-
Operative time (minute) Mean ± SD 71.67 ± 23.61 boprophylaxis is still debatable. Since most VTE complications
occur posthospital discharge, a comprehensive approach to
Complications Bleeding 0 (0%) thromboprophylaxis is necessary, particularly in patients at high
Leakage and/or fistulas 0 (0%) risk. After bariatric surgery, LMWH was confirmed to be superior
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Stricture 0 (0%) to unfractionated heparin (UFH) for thromboprophylaxis, with a
Twist 0 (0%) comparable risk of bleeding.
Pulmonary emboli 2 (6.1%) In this descriptive cross-sectional study, 6.1% of patients
DVT 0 (0%) had PE as a postoperative complication, and two patients (6.1%)
Re-operation 0 (0%) died. Moreover, we demonstrated that mini-gastric bypass
operation had a significantly longer mean operative duration of
Re-admission 0 (0%) 120.0 ± 9.49 minutes than sleeve operation 60.93 ± 3.11 minutes
Mortality 2 (6.1%) (p <0.001). In terms of the predictors of postoperative VTE,
Hospital stay (days) (Mean ± SD) 2.0 ± 0.0 old age (p = 0.013), long duration of peroration (p = 0.005),
Range (2–2) and previous history of VTE (p = 0.045) were associated with
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a higher risk of developing postoperative VTE. Magee et al.,
Table 3: Criteria of patient develop in PE regarding different parameters reported that among 735 patients who underwent bariatric
surgery and received up to 3 weeks of LMWH, the incidence
(N = 2) of postoperative VTE and bleeding was 0%. Similarly, in those
Age Mean ± SD 44.50 ± 5.36 managed with 10 days of tinzaparin, Tseng et al. reported a 0.5%
Range 40–49 postoperative VTE. Similarly, the incidence of postoperative
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Sex Male 0 (0%) bleeding varies from 0 to 6%. On the contrary, Froehling et al.
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Female 2 (100%) showed that VTE’s cumulative incidence ranged between 0.3
Type of surgery Sleeve 1 (50%) and 2.1% in patients who underwent 402 bariatric operations.
Mini gastric bypass 1 (50%) Furthermore, they highlighted that the patients’ age was an
BMI Mean ± SD 49.0 ± 8.49 independent predictor of postoperative VTE (HR = 1.89, 95%
Range 43–55 CI: 1.01, 3.55). This variance in the occurrence of postoperative
Type of Mechanical pharmacological 2 (100%) VTE is possibly attributable to variations in patient condition,
prophylaxis type of procedure, thromboprophylaxis dose and duration, and
Time of incidence Mean ± SD 8.50 ± 4.95 assessed outcomes.
PE after surgery Range 5–12 In the bariatric surgery population, fatal PE is a common cause
(days) of postoperative mortality. 25,26 The previous studies reported that
old age, postoperative anastomotic leakage, history of smoking,
and previous VTE are associated with a higher risk of VTE following
(p <0.001). The mean hospital stay was 2 days. Regarding bariatric surgery. In several studies, male sex was associated with
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postoperative complications, 6.1% of patients had PE as a an increased VTE risk among patients with bariatric surgery. 26,28 Two
postoperative complication and two patients (6.1%) died (Table 2).
studies reported a significant association between patient smoking
Incidence of VTE at the End of Follow-up status and VTE’s potential risk. 27,29 The presence of potential
Two patients developed PE (6.1%). The first patient was female hypercoagulability markers among patients in the bariatric
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aged 40-years-old who underwent (SG). Her BMI was 43 kg/m procedure has also been evaluated, but there was no observed
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and she had a history of diabetes, hypertension, and VTE 5 years association with clinical VTE.
ago. On the 5th postoperative day, she complained of shortness With regards to procedure-related factors, procedure type,
of breath and chest pain, which was followed by the diagnosis operative time, and postoperative complications are the main
of PE and ICU admission. The second patient was a female aged risk factors of VTE. Compared to laparoscopic procedures, the
49-years-old who underwent OAGB operation. Her BMI was open procedure was reported to be associated with a higher risk
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2
55 kg/m and she had a history of diabetes, HTN, and chronic of VTE. Regarding the duration of the procedure, Finks et al.
obstructive pulmonary disease (COPD). Twelve days after the recorded an increased risk (86%) of VTE with an operative time of
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operation, she complained of chest pain, palpitations, shortness more than 3 hours. Chan et al. found that operatives with long-
of breath, which was followed by the diagnosis of PE and ICU duration excessed 3 hours are associated with an increased risk
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admission (Table 3). of postoperative VTE. Regarding the type of surgery, revision
surgeries were reported to be correlated with an increased VTE
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risk. It was also reported that Roux en Y gastric bypass (RYGB)
dIscussIon was associated with the postoperative anastomotic leak, which
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VTE is a disease that can be prevented, and thromboprophylaxis in turn increases the VTE risk. In contrast to adjustable gastric
is a key strategy to minimize post-bariatric VTE mortality and band procedures, Finks et al. found an increased risk of VTE with
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morbidity. The reverse placement of Trendelenburg and (SG), laparoscopic gastric bypass, and open RYGB. Masoomi et al.
pneumoperitoneum use during laparoscopy reduces the venous found that in comparison with other bariatric procedures, GBS
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return to the heart, further increasing the prothrombotic carries greater VTE risks.
state. 17,19 VTE risk is also increased by postoperative pain and Our study has some limitations, including the cross-sectional
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poor ambulation. Even with the challenges of preventing these nature, which is associated with several risks of bias. Moreover, the
World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022) 23