Caruso Francesco, Cesana Giovanni, Lomaglio Laura, Cioffi Stefano, Ciccarese Francesca, Uccelli Matteo, Olmi Stefano
Department of General, Oncological and Laparoscopic Surgery, Policlinico San Marco , Osio Sotto, Italy .
J Laparoendosc Adv Surg Tech A. 2017 Oct;27(10):987-996. doi: 10.1089/lap.2017.0190. Epub 2017 Jun 12.
Portomesenteric vein thrombosis (PMVT) is considered a rare and potentially fatal complication of bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is one of the most performed bariatric procedures in the world. PMVT in LSG was first reported in 2009 by Berthet et al. in a thrombophilic patient. No data exist regarding the real prevalence of this complication specifically after LSG.
We examined retrospectively all the clinical records of patients who underwent LSG for morbid obesity from January 2011 to December 2016. Moreover, we performed a literature search of PubMed, Medscape, and EMBASE databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
2854 patients underwent LSG for morbid obesity from January 2011 to December 2016. The retrospective analysis of our records revealed only 1 case of PMVT. The 18 studies selected include 62 cases of PMVT after LSG with a prevalence of 0.52% (ranging from 0.2% to 1.81%) and a mortality rate of 1.61%.
PMVT is an infrequent but not rare complication in patients who undergo LSG. Short-course antithrombotic prophylaxis (<10 days) could increase the risk of this complication. The authors recommend a postoperative prophylaxis with sodium enoxaparin 40 mg sc once a day for 4 weeks. PMVT mortality in patients who undergo LSG is lower than other causes of portal vein thrombosis (hepatic cirrhosis, tumors, myeloproliferative disorders, etc.) If risk factors for PMVT are present preoperatively, the authors recommend a prophylaxis with sodium enoxaparin 40 mg sc twice daily for 4 weeks.
门静脉肠系膜静脉血栓形成（PMVT）被认为是减肥手术中一种罕见且可能致命的并发症。腹腔镜袖状胃切除术（LSG）是全球开展最为广泛的减肥手术之一。2009年，Berthet等人首次报道了一名血栓形成倾向患者在接受LSG后发生PMVT。目前尚无关于该并发症在LSG术后实际发生率的具体数据。
我们回顾性分析了2011年1月至2016年12月期间因病态肥胖接受LSG手术患者的所有临床记录。此外，我们按照系统评价和Meta分析的首选报告项目（PRISMA）指南，对PubMed、Medscape和EMBASE数据库进行了文献检索。
2011年1月至2016年12月期间，2854例患者因病态肥胖接受了LSG手术。对我们记录的回顾性分析仅发现1例PMVT。所选的18项研究包括62例LSG术后发生PMVT的病例，发生率为0.52%（范围为0.2%至1.81%），死亡率为1.61%。
PMVT在接受LSG手术的患者中是一种不常见但并非罕见的并发症。短期抗血栓预防（<10天）可能会增加该并发症的风险。作者建议术后使用依诺肝素钠40mg皮下注射，每日一次，持续4周进行预防。接受LSG手术患者的PMVT死亡率低于门静脉血栓形成的其他原因（肝硬化、肿瘤、骨髓增殖性疾病等）。如果术前存在PMVT的危险因素，作者建议使用依诺肝素钠40mg皮下注射，每日两次，持续4周进行预防。
