Article

Portomesenteric venous thrombosis after laparoscopic surgery: a systematic literature review.

Department of Surgery, University of California, San Francisco, San Francisco, CA 94143-0790, USA.
Archives of surgery (Chicago, Ill.: 1960) (impact factor: 4.32). 07/2009; 144(6):520-6. DOI:10.1001/archsurg.2009.81 pp.520-6
Source: PubMed

ABSTRACT Portomesenteric venous thrombosis (PVT) is an uncommon but potentially lethal condition reported after several laparoscopic procedures. Its presentation, treatment, and outcomes remain poorly understood, and possible etiologic factors include venous stasis from increased intra-abdominal pressure, intraoperative manipulation, or damage to the splanchnic endothelium and systemic thrombophilic states.
Systematic literature review.
Academic research.
We summarized the clinical presentation and outcomes of PVT after laparoscopic surgery other than splenectomy in 18 subjects and reviewed the treatment strategies.
Systematic review of the literature on PVT after laparoscopic procedures other than splenectomy.
Eighteen cases of PVT following laparoscopic procedures were identified after Roux-en-Y gastric bypass (n = 7), Nissen fundoplication (n = 5), partial colectomy (n = 3), cholecystectomy (n = 2), and appendectomy (n = 1). The mean patient age was 42 years (age range, 20-74 years). Systemic predispositions toward venous thrombosis were identified in 11 patients. Clinical symptoms consisted primarily of abdominal pain manifested, on average, 14 days (range, 3-42 days) after surgery. Thrombus location varied, but 8 patients had a combination of portal and superior mesenteric venous thrombosis. Sixteen patients were treated with anticoagulation therapy. Ten patients underwent major interventions, including exploratory laparotomy in 6 patients and thrombolytic therapy in 4 patients. Six patients had complications, and 2 patients died.
Portomesenteric venous thrombosis following laparoscopic surgery usually manifests as nonspecific abdominal pain. Computed tomography can readily provide the diagnosis and demonstrate the extent of the disease. Treatment should be individualized based on the extent of thrombosis and the presence of bowel ischemia but should include anticoagulation therapy. Venous stasis from increased intra-abdominal pressure, intraoperative manipulation of splanchnic vasculature, and systemic thrombophilic states likely converges to produce this potentially lethal condition.

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    Article: Laparoscopic gastric plication for the treatment of morbid obesity: a review.
    Michael Kourkoulos, Emmanouil Giorgakis, Charalampos Kokkinos, Theodoros Mavromatis, John Griniatsos, Nikolaos Nikiteas, Christos Tsigris
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    ABSTRACT: Introduction. Laparoscopic greater curvature plication is an operation that is gaining ground in the treatment of morbid obesity, as it appears to replicate the results of laparoscopic sleeve gastrectomy with fewer complications. Aim. Review of current literature, especially results on weight loss and complications. Method. 11 (eleven) published articles on laparoscopic gastric plication, of which 1 preclinical study, 8 prospective studies for a total of 521 patients and 2 case reports of unusual complications. Results. Reported Paracentage of EWL in all studies is comparable to Laparoscopic Sleeve Gastrectomy (around 50% in 6 months, 60-65% in 12 months, 60-65% in 24 months) and total complication rate is at 15,1% with minor complications in 10,7%, major complications in 4,4%. Reoperation rate was 3%, conversion rate was 0,2%, and mortality was zero. Conclusion. Current literature on gastric plication and its modifications is limited and sketchy at times. Low cost, short hospital stay, absence of prosthetic material, and reversibility make it an attractive option. Initial data show that LGCP is effective for short- and medium-term weight loss, complication and reoperation rates are low, and GERD symptoms are unaffected. More data is required, and randomized control trials must be completed in order to reach safe conclusions.
    Minimally invasive surgery. 01/2012; 2012:696348.
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    Article: Portomesenteric Thrombosis Following Laparoscopic Bariatric Surgery: Incidence, Patterns of Clinical Presentation, and Etiology in a Bariatric Patient Population.
    David Goitein, Ibrahim Matter, Asnat Raziel, Andrei Keidar, David Hazzan, Uri Rimon, Nasser Sakran
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    ABSTRACT: OBJECTIVE To describe the incidence of, the patterns of clinical presentation of, and the reasons for portomesenteric vein thrombosis among patients who underwent laparoscopic bariatric surgery. DESIGN Retrospective, multicenter study. SETTING Six academic bariatric centers. PATIENTS Morbidly obese patients diagnosed with portomesenteric vein thrombosis following laparoscopic bariatric surgery between January 2007 and June 2012. MAIN OUTCOME MEASURES Clinical presentation, diagnostic measures used, treatments employed, outcome, and hematologic workup of patients. RESULTS Of 5706 patients who underwent laparoscopic bariatric surgery, 17 (0.3%) had portomesenteric vein thrombosis, 16 after sleeve gastrectomy and 1 following adjustable gastric banding. Seven patients were women, the mean age was 38 years, and the mean body mass index was 44.3. The median time to presentation was 10.1 days, and the median time to diagnosis was 11.7 days. New-onset epigastric pain was present in all patients, whereas other signs and symptoms were sporadically found. Computed tomography was performed and was diagnostic in 16 cases. Ultrasonography was used for 9 patients, and positive results were found for 8 of these patients. Patients were treated by anticoagulation with subcutaneous low-molecular-weight heparin (n = 15) or intravenous heparin (n = 2), followed by warfarin sodium. One patient underwent transhepatic portal infusion of streptokinase. Three patients required surgery: laparoscopic splenectomy due to infarct and abscess for 1 patient and laparotomy for 2 patients (with necrotic small-bowl resection for 1 of these patients). There were no deaths. CONCLUSIONS Portomesenteric vein thrombosis is rare after laparoscopic bariatric surgery. Familiarity with this dangerous entity is important. Prompt diagnosis and care, initiated by a high index of suspicion, is crucial.
    Archives of surgery (Chicago, Ill.: 1960) 12/2012; · 4.32 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

abdominal pain manifested
 
age range
 
anticoagulation therapy
 
clinical presentation
 
Clinical symptoms
 
Computed tomography
 
exploratory laparotomy
 
nonspecific abdominal pain
 
partial colectomy
 
Portomesenteric venous thrombosis
 
possible etiologic factors
 
Roux-en-Y gastric bypass
 
splanchnic endothelium
 
Systematic literature review
 
Systematic review
 
Systemic predispositions
 
systemic thrombophilic states
 
thrombolytic therapy
 
Thrombus location varied
 
venous stasis