Portomesentric Vein Thrombosis: Our Experience of 3527 Laparoscopic Bariatric Surgery Procedures in Qatar

Background: Portomesentric vein thrombosis (PMVT) is a rare but potentially serious and life threatening complication that may happen following laparoscopic bariatric surgery (LBS). Multifactorial local and systemic prothrombotic factors have been identitfied for PMVT development. In this study we intend to assess: 1) Incidence of PMVT post LBS in our patients' population; 2) Our protocol for DVT prophylaxis with applying the enhanced recovery after surgery (ERAS) protocol and application of certain intra-operative techniques in PMVT prevention following LBS. Methods: This is a retrospcetive review of patients who underwent LBS between February 2011 and December 2016, who developed PMVT following LBS. Patients' charts were reviewed and data were extracted (patients' demographics, associated comorbidities, potential PMVT risk factors, LBS procedure undertaken, peri-operative details). In addition, the clinical features were also retrieved (PMVT presenting symptoms, management, blood investigations and thrombophilia screening). Results: Out of 3527 patients who underwent LBS in our center during this period, 4 patients developed PMVT comprising an incidence of 0.1%. Thrombophilic work up of patients who developed PMVT revealed that all had thrombosis risk factors (hyper-homocysteinema, anti-nuclear antibody, SLE, mutant Factor V Leiden, Protein C, Protein S deficiency). All managed medically and none required surgical intervention. There was no mortality. Conclusion: Though no consensus concerning PMVT prophylaxis in LBS patients exists, we propose that application of a standard multimodal thromboembolic prophylaxis mainly mechanical prophylaxis, intra-operative techniques and ERAS principles as showed, were major reasons for low PMVT incidence. All patient who developed PMVT post LBS had positive diagnostic throbophilia work up. Following standardized non-pharmacological thromboembolic prophylaxis in LBS patients questions the benefit of pharmacological thromboembolic prophylaxis.