Laparoskopik Sleeve Gastrektomi Sonrası Portomezenterik Venöz Tromboembolinin Non-Operatif Yönetimi ve Uzun Dönem Anti Koagülan Proflaksinin Önemi

Amaç: Portomezenterik ven trombozu (PMVT), Laparoskopik sleeve gastrektominin (LSG) nadir ve potansiyel olarak hayatı tehdit eden bir komplikasyonudur. Etkin antikoagülan proflaksisi ile çoğu zaman tedaviye olumlu yanıt alınmaktadır. LSG sonrası PMVT gelişen hastaların insidans, klinik özellikler, takip ve tedavisini irdelemeyi amaçladık. Yöntemler: 2010 - 2019 yılları arasında obezite nedeniyle LSG uygulanan 683 hasta retrospektif olarak tarandı. Tüm hastalarda tanı, abdominal bilgisayarlı tomografi (BT) taraması ile konuldu. Tüm hastaların yaş, cinsiyet, vücut kitle indeksi (BMİ), tromboz risk faktörleri, ameliyat verileri, PMVT klinik özellikleri, tanı ,takip ve tedavi bulguları ve görüntüleme verileri analiz edildi. Bulgular: Toplam 683 hastaya LSG uygulandı ve 4 hastada (%0,58) PMVT gelişti. Tüm hastaların yaş ortalaması 36.25±6.89 (29-45) yıl, 3 hasta kadındı. Ortalama BMİ 36.42±0,95 (35,1-37,3) kg/m2 idi. 3 hastada sigara öyküsü vardı. Tüm hastalara antikoagülan tedavi uygulandı ve Konservatif tedaviye yanıt alındı. Ortalama yatış süresi 2.75±0.5 gün (2-3). İkinci yatış süreleri ortalama 8.75 gün (5-8 gün) idi. Bir hastada protein c eksikliği tanısı konuldu. Herhangi mortalite veya morbidite izlenmedi. Sonuçlar: PMVT, bariatrik cerrahiyi takiben gelişen nadir fakat ciddi bir komplikasyondur. Konservatif tedavi esastır. Alta yatan nedene yönelik tedavi mutlaka gerektirmektedir. İnce bağırsak nekrozu için cerrahi müdahale şarttır. Uzun dönem antikoagülan profilaksisi LSG sonrası hastalar için PMVT'nin önlenmesinde ve PMVT gelişmesi durumunda iyi prognozlu seyretmesinde rol alabilmektedir. PMVT'nin uzun dönem hasta sonuçları üzerindeki etkisini değerlendirmek amacıyla daha uzun süreli takiple ve daha fazla hasta popülasyonu ihtiyaç vardır.

Anahtar Kelimeler:

Laparoskopik sleeve gastrektomi, Portomezenterik ven trombozu, Antikoagülan

The Non-Operative Management of Portomesenteric Venous Thromboembolism After Laparoscopic Sleeve Gastrectomy and the Importance of Long-Term Anticoagulant Prophylaxis, A University Hospital Experience

Aim: Portomesenteric venous thrombosis (PMVT) is a rare and life-threatening complication of laparoscopic sleeve gastrectomy (LSG). Treatment is usually established with proper anticoagulant prophylaxis. In this study, we aimed to focus on the incidence, clinical characteristics, follow-up, and treatment of patients who have undergone LSG procedures and developed PMVT. Material and Methods: Between the years of 2010 – 2019, we retrospectively screened 683 patients who had undergone LSG operation due to obesity. In all patients, the diagnosis was established with abdominal computerized tomography (CT). Age, gender, body mass index (BMI), thrombosis risk factors, surgical details, PMVT clinical characteristics, follow-up, and treatment features were analyzed in patients diagnosed with PMVT. Results: LSG was performed on 683 patients and four patients (0.58%) developed PMVT. The average age of patients was 36.25±6.89 (29-45) years and only three patients were female. The average BMI was 36.42±0.95 (35.1-37.3) kg/m2. Three patients had a smoking history. All patients received anticoagulant therapy and responded to conservative treatment. The average length of stay in the hospital was 2.75±0.5 days (2-3). The average length of stay on the second admission to the hospital was 8.75 days (5-8 days). One patient had the diagnosis of protein C deficiency. No mortality or morbidity was observed. Conclusion: PMVT is a rare but serious complication following bariatric surgery. Conservative treatment is fundamental. Treatment is required based on any underlying disease if present. Surgical intervention is required for small bowel necrosis. The findings of our study support the information that long-term anticoagulant prophylaxis plays a role in preventing PMVT after LSG, as well as improving prognosis on patients who have already developed PMVT. To evaluate the long-term effects of PMVT on patients, a longer time of follow-up and a larger patient population is needed.

Keywords:

Laparoscopic sleeve gastrectomy, Portomesenteric venous thrombosis, Anticoagulant,

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