Department of Surgery, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health, Manhasset, NY, 11030, USA.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA.
Obes Surg. 2023 Oct;33(10):2991-3007. doi: 10.1007/s11695-023-06714-z. Epub 2023 Jul 31.
Portomesenteric vein thrombosis (PMVT) is a rare but potentially fatal complication of sleeve gastrectomy (SG). The rising prevalence of SG has led to a surge in the occurrence of PMVT, while the associated risk factors have not been fully elucidated. This study aims to determine the incidence and risk factors of PMVT in patients undergoing SG.
A comprehensive literature search was performed in PubMed and EMBASE databases. Proportion and regression meta-analyses were conducted.
In a total of 76 studies including 101,914 patients undergoing SG, we identified 357 patients with PMVT. Mean follow-up was 14.4 (SD: 16.3) months. The incidence of PMVT was found to be 0.50% (95%CI: 0.40-0.61%). The majority of the population presented with abdominal pain (91.8%) at an average of 22.4 days postoperatively and PMVT was mainly diagnosed with computed tomography (CT) (96.0%). Hematologic abnormalities predisposing to thrombophilia were identified in 34.9% of the population. Advanced age (p=0.02) and low center volume (p <0.0001) were significantly associated with PMVT, while gender, BMI, hematologic abnormality, prior history of deep vein thrombosis or pulmonary embolism, type of prophylactic anticoagulation, and duration of prophylactic anticoagulation were not associated with the incidence of PMVT in meta-regression analyses. Treatment included therapeutic anticoagulation in 93.4% and the mortality rate was 4/357 (1.1%).
PMVT is a rare complication of sleeve gastrectomy with an incidence rate <1% that is associated with low center volume and advanced age but is not affected by the duration or type of thromboprophylaxis administered postoperatively.
门脉肠系膜静脉血栓形成（PMVT）是袖状胃切除术（SG）的一种罕见但潜在致命的并发症。随着 SG 的广泛应用，PMVT 的发生率也随之上升，但其相关的危险因素尚未完全阐明。本研究旨在确定行 SG 患者中 PMVT 的发生率和危险因素。
在 PubMed 和 EMBASE 数据库中进行全面的文献检索。进行了比例和回归荟萃分析。
共纳入 76 项研究，包括 101914 例接受 SG 的患者，我们共发现 357 例 PMVT 患者。平均随访时间为 14.4（SD：16.3）个月。PMVT 的发生率为 0.50%（95%CI：0.40-0.61%）。大多数患者在术后平均 22.4 天出现腹痛（91.8%），且主要通过计算机断层扫描（CT）诊断 PMVT（96.0%）。有 34.9%的患者存在易栓症的血液学异常。高龄（p=0.02）和中心手术量低（p<0.0001）与 PMVT 显著相关，而性别、BMI、血液学异常、深静脉血栓形成或肺栓塞史、预防性抗凝药物的类型和预防性抗凝的持续时间在元回归分析中与 PMVT 的发生率无关。治疗包括 93.4%的患者进行了抗凝治疗，死亡率为 4/357（1.1%）。
PMVT 是袖状胃切除术的一种罕见并发症，发生率<1%，与中心手术量低和年龄大有关，但与术后预防性抗凝的持续时间或类型无关。
