Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy.

INTRODUCTION: Portal and mesenteric vein thrombosis are relatively uncommon surgical complications, with difficult diagnosis and potentially severe consequences due to higher risk of bowel infarction. The purpose of this study was to present a series of patients who developed postoperative portal vein thrombosis after laparoscopic sleeve gastrectomy. METHODS: This is a retrospective analysis of patients who underwent sleeve gastrectomy between June 2005 and June 2011 who developed portal vein thrombosis. Demographic data, personal risk factors, family history of thrombosis, and postoperative results of thrombophilia study were analyzed in this study. RESULTS: A total of 1,713 laparoscopic sleeve gastrectomies were performed. Seventeen patients (1 %) developed portal vein thrombosis after surgery. Of the 17 patients, 16 were women, 8 had a history of smoking, 7 used oral contraceptives, and 2 had a family history of deep vein thrombosis of the lower limbs. All patients were discharged on the third day of surgery with no immediate complications. Symptoms presented at a median of 15 (range, 8-43) days after surgery with abdominal pain in most cases. One case required emergency laparotomy and splenectomy because of an active bleeding hematoma with massive portomesenteric vein thrombosis. In 11 cases, a thrombosis of the main portal vein was identified, in 15 the right portal branch was compromised, and in 10 the left portal branch. Eleven patients presented thrombosis of the superior mesenteric vein, and ten patients presented a concomitant thrombosis of the splenic vein. A massive PMVT was presented in six cases. Seven patients had a positive thrombophilia study. CONCLUSIONS: Portal vein thrombosis and/or mesenteric thrombosis are relatively uncommon complications in patients undergoing bariatric surgery. In this series, the portomesenteric vein thrombosis was the most common complication after LSG in a high-volume center.

Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1,000 cases and 3-year follow-up.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is an emerging surgical technique with encouraging results. The objective of this study is to report surgical results after 1,000 consecutive LSG cases as a stand-alone procedure for morbid obesity during a 3-year follow-up. METHODS: Data were obtained by review of our prospectively maintained database, patients' clinical charts, and phone interview of all patients who underwent LSG in our institution from December 2005 to February 2010. RESULTS: There were 773 (77.3%) women whose preoperative age and BMI was 36.9 ± 11.5 years and 37.4 ± 4.0 kg/m(2), respectively. The most common co-morbid conditions were insulin resistance 55.1%, dyslipidemia 45.5%, arterial hypertension 23.1%, hypothyroidism 15.4% and non-alcoholic fatty liver disease 12%. Excess weight loss was as follows: 1 year 86.6%, 2 years 84.1%, and 3 years 84.5%. Early and late complications occurred in 34 (3.4%) and 20 (2.0%) patients, respectively. Reoperation was required in seven (0.7%) patients. There was no mortality during follow-up. CONCLUSIONS: LSG seems to be a safe and effective surgical technique for morbid obesity as a stand-alone procedure.