ABSTRACT
BACKGROUND: Worldwide, the laparoscopic sleeve gastrectomy (LSG) is becoming the dominant bariatric procedure due to its reliable weight loss and low complication rate. Portomesenteric vein thrombosis (PVT) is an uncommon complication of LSG with an incidence of .3% to 1% and can lead to serious consequences, such as bowel ischemia and death. OBJECTIVES: This paper will present the presentation, risk factors, treatment, and long-term outcomes of patients who had PVT post-LSG. SETTING: Five bariatric centers in a private setting in Australia. METHODS: Retrospective data were collected from 5 bariatric centers across Australia from 2007 to 2016. RESULTS: Across 5 centers, 5951 patients underwent LSG; 18 had recognized PVT (.3%). The mean body mass index was 41.8. Of patients, 39% had a history or family history of deep vein thrombosis. The average time to diagnosis was 13 days (range, 5-25). Treatment was nonoperative with anticoagulation in 94%. One patient required operative management with bowel resection. All patients were discharged on therapeutic anticoagulation. Mean total weight loss was 27.7% (14.8%-66.3%). Mean follow-up was 10 months. There were no mortalities. Given the low number of patients, no statistically significant data could be derived. CONCLUSION: PVT is difficult to diagnose, with significant consequences. The presenting symptoms are nonspecific, and a high index of suspicion needs to be maintained. Cross-sectional imaging with computed tomography of the abdomen is recommended. Patients with PVT post-LSG without previous risk factors can be anticoagulated for 3 to 6 months with an international normalized ratio of 2 to 3.
Subject(s)
Bariatric Surgery/adverse effects , Gastrectomy/adverse effects , Laparoscopy/adverse effects , Mesenteric Veins , Portal Vein , Venous Thrombosis/etiology , Adult , Anticoagulants/therapeutic use , Australia , Early Diagnosis , Female , Humans , Male , Middle Aged , Obesity, Morbid/surgery , Postoperative Complications/diagnostic imaging , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Prospective Studies , Retrospective Studies , Tomography, X-Ray Computed , Ultrasonography, Doppler, Duplex , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapyABSTRACT
BACKGROUND: Laparoscopically inserted adjustable gastric bands are an effective means of weight reduction for obese patients. METHODS: The Swedish Adjustable Gastric Band was evaluated prospectively in a consecutive series of 273 patients from August 1996 to March 2003. RESULTS: The first 58 patients had their band sited by the 'peri-gastric' technique, with the subsequent 215 using the 'pars flaccida' technique, which provides better posterior fixation of the band. Results from these two groups were considered separately. Prolapse of the stomach through the band was the major complication occurring in 13 of the 58 peri-gastric patients (22.4%). Median preoperative body mass index (BMI) was 42.1, falling below 30 by 2 years. In the pars flaccida group there were no instances of prolapse, but the major complication was three cases of band erosion (1.4%). Median preoperative BMI was 42.9 for this group, falling to 32 by 3 years. There was one death in the series due to myocardial infarction. CONCLUSIONS: Results compare favourably with other published adjustable gastric band series. Weight loss with the SAGB appears durable overall with an acceptable complication rate once an appropriate technique is employed. Consistent life-long follow up is necessary to achieve the best result.