Blood coagulation changes in laparoscopic gastrectomy: morbid obese vs normal patients

ABSTRACT

BACKGROUND: Patients with morbid obesity have higher risk of fatal thromboembolic episodes than non-obese patients. We aimed to identify perioperative changes in blood coagulation for the patients undergoing bariatric surgery and compare thromboelastography (TEG) findings with non-obese patients. METHODS: 24 patients with morbid obesity (group B) and 22 patients with stomach cancer (group S) who undergoing laparoscopic Roux-en-Y gastric bypass surgery were prospectively studied. Laboratory coagulation-related tests and TEG were conducted immediately after anesthetic induction (T0), at 2 hours after surgical incision (T1), and 2 hours after the end of surgery (T2). RESULTS: Group B had higher serum lactate, fibrinogen, maximum amplitude in TEG findings, and shorter activated partial thromboplastin time (aPTT) than group S at T0 (P < 0.05). In group B, serum fibrinogen degradation products (FDP) at T2 and base deficit at T1 and T2 were higher, and aPTT was shorter than those at T0 (P < 0.05). R-time and k-time showed gradual shortening toward T2. alpha-angle at T1 and coagulation index at T2 increased significantly from those at T0 in the group B (P < 0.05). However, group B failed to show any significant differences from the group S in TEG and coagulation-related laboratory findings except platelet count and serum fibrinogen level at T1 and T2. CONCLUSIONS: Preoperatively, morbidly obese patients had more activated coagulation profiles than non-obese patients. However, remarkable perioperative changes in TEG findings could not be definitely observed between two groups.