Patricio Fajnwaks

Incidence of deep vein thrombosis in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass

BACKGROUND To define the incidence of deep vein thrombosis in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass. METHODS A retrospective study was conducted for all patients undergoing laparoscopic Roux-en-Y gastric bypass from 2004 to 2006. The data collected included patient demographics, body mass index, operative time, conversion rate, thromboprophylaxis measures, hospital stay, and complications. RESULTS Of the 618 patients included in the study, 451 (73%) were women and 167 (27%) were men, with a mean age of 44 years (range 18-78). The preoperative body mass index was 49 kg/m(2) (range 35-90). All patients received the same thromboprophylaxis regimen. All surgical procedures were performed and completed laparoscopically, with a mean operative time of 93 minutes (range 50-196). All patients underwent lower extremity color Doppler ultrasonography within the first 24 hours after the surgical procedure. The mean hospital stay was 4 days (range 2-21). The most common in-hospital complication was basal atelectasis in 52 patients (8.4%), followed by gastrointestinal bleeding in 10 (1.6%), and anastomotic leak in 6 (1%). The postoperative follow-up visits were done at 2, 8, 12, 24, and 52 weeks after surgery; no mortality occurred. The overall rate of deep vein thrombosis in the group of 500 consecutive patients was .2%, with no clinically significant pulmonary embolism; 9 patients presented with postoperative bleeding. CONCLUSION The overall rate of deep vein thrombosis in this group of patients was low, most probably because of the use of thromboprophylaxis.

Hemorrhagic and Thromboembolic Complications after Bariatric Surgery in Patients Receiving Chronic Anticoagulation Therapy

BackgroundPerioperative management of bariatric surgical patients receiving chronic anticoagulation requires an understanding of potential hemorrhagic and thromboembolic risks. The aim of this study is to evaluate hemorrhagic and thromboembolic complications in morbidly obese patients who are on oral anticoagulation treatment and subsequently undergo laparoscopic bariatric surgery.MethodsThe medical records of all laparoscopic Roux-en-Y gastric bypass (LRYGB) patients from June 2001 to March 2006 were retrospectively reviewed. In addition, data of patients who received chronic anticoagulation therapy with Coumadin and underwent laparoscopic Roux-en-Y gastric bypass was analyzed. Clinical parameters included length of hospitalization, hemorrhagic complications, thromboembolic complications, conversion rate, reoperation, and blood transfusion.ResultsDuring the study period, 1,700 consecutive patients underwent bariatric surgery for the treatment of morbid obesity. Of these, 21 patients were treated with chronic oral anticoagulation; 3 of the 21 (14%) had hemorrhagic complications: one patient had intraluminal hemorrhage and two patients had intraabdominal hemorrhage. Two patients required blood transfusion, and one patient underwent surgical reintervention. None of the 21 laparoscopic operations were converted to open procedures. There were no postoperative mortalities, and there were no thromboembolic events in this series.ConclusionsLaparoscopic bariatric surgery can be performed relatively safely in morbidly obese patients who are treated with chronic oral anticoagulation. Even in the presence of bleeding, patients can be successfully treated without the need for reoperation.