ABSTRACT: Bariatric patients are at significant risk for venous thromboembolism (VTE) and a subset may benefit from retrievable inferior vena cava filters (rIVCFs). Optimal VTE prophylaxis and a consensus on factors which make bariatric patients high risk have not been established. This study describes our experience with the use of rIVCFs in combination with chemoprophylaxis for high-risk bariatric surgery patients.
A retrospective review was performed of high-risk patients bariatric surgery patients. Patients with a hypercoaguable condition, prior history of VTE, body mass index (BMI) > 55 kg/m(2), and severe immobility were considered high risk. Patients underwent rIVCF placement and standard chemoprophylaxis. A venogram was performed at retrieval.
Forty-four patients, age of 48 ± 12 years and BMI of 58.4 ± 9.4 kg/m(2) underwent gastric bypass with rIVCF placement. Follow-up was 204 days. One patient had a preoperative deep venous thrombosis (DVT). All patients received chemoprophylaxis and rIVCF placement. Indications for rIVCF were BMI (68%), prior VTE (30%), and immobility (2%). The operation was performed laparoscopically in all patients, and the mean operative time was 106.1 ± 21.6 min and length of stay was 3.1 ± 1.2 days. Postoperative venous duplex revealed two DVTs (5%). Retrieval was successful in 28 patients. No significant thrombus was found on venogram. Two minor complications of filter placement occurred. One mortality occurred due to MI, and no pulmonary emboli were clinically evident.
rIVCFs in our cohort of high-risk bariatric surgery patients was associated with an acceptably low incidence of DVT (5%) and no clinically evident PE. Despite safe removal after long dwell times, previous data suggest that rIVCFs are associated with a higher incidence of VTE. Thus, filters, if placed, should be removed once the risk of VTE has passed. Larger multicenter studies are needed to truly identify long-term safety and efficacy of rIVCFs.
Obesity Surgery 11/2010; 21(10):1580-4. · 3.29 Impact Factor
ABSTRACT: Cystic lymphangiomas are rare, benign anomalies of the lymphatic system. More than 95% of cystic lymphangiomas occur in the head, neck, and axilla with only 1% in the retroperitoneum. Most of these cases are diagnosed by the second year of life with only a handful of adult cases. Once a symptomatic cystic lesion of the abdomen or retroperitoneum is diagnosed, treatment usually consists of surgical excision. Traditionally, surgery requires a laparotomy. This paper describes a patient with a retroperitoneal cyst who underwent a successful laparoscopic resection. The etiology and management of adult retroperitoneal cysts are reviewed as well.
Surgical laparoscopy, endoscopy & percutaneous techniques 06/2010; 20(3):e114-6. · 1.23 Impact Factor
ABSTRACT: Subxiphoid hernias are difficult to repair. This study attempts to identify risk factors associated with incisional hernia formation after median sternotomy.
A retrospective review was conducted on patients undergoing subxiphoid incisional hernia repair between 1995 and 2002. The study group was compared with a group undergoing similar cardiothoracic procedures as to body mass index (BMI), comorbidities, complications, tobacco use, length of stay, ICU stay, bypass time, transfusion requirements, and wound infections. Statistical analysis utilized Student's t-test, chi-square, and Kaplan-Meier analysis.
A total of 117 subxiphoid hernias were repaired; 45 were used for comparison with a matched cohort of 79 patients. Average time between sternotomy and hernia repair was 24.3 months (+/-16.8) with 22 (49%) patients developing hernias within 2 years. Mean followup was 48 months. The study group differed significantly from the nonhernia group in age (56.6 +/- 13.0 versus 62.2 +/- 8.9, p = 0.01), mean length of stay (16.3 +/- 22.8 versus 10.2 +/- 6.7, p = 0.03), BMI (29.6 +/- 4.5 versus 27.2 +/- 4.5, p = 0.01), number of transplantation patients (10 versus 1, p = 0.0003), and presence of sternal wound infection (18% versus 3.9%, p = 0.02). Multivariate analysis revealed significance in regard to transfusion requirements (p = 0.015) and approached statistical significance with BMI (p = 0.058). Of the 45 patients undergoing hernia repair, 31(69%) had a mesh repair and 10 (32%) patients recurred. Six (43%) patients without a mesh repair recurred. Seventy-five percent of the patients with sternal wound infections developed recurrent hernias.
Transfusion requirements, BMI, and sternal wound infections might be associated with subxiphoid hernias after median sternotomy. Sternal wound infection increases the risk of recurrent incisional hernia.
Journal of the American College of Surgeons 08/2005; 201(1):71-6. · 4.55 Impact Factor