Mesenteric Venous Thrombosis After Laparoscopic Sleeve Gastrectomy: Pathophysiology and Literature Review

Abstract

In the last 10 years, laparoscopic sleeve gastrectomy has become an increasingly popular surgical option for morbidly obese patients. Mesenteric venous thrombosis, as a complication of laparoscopic sleeve gastrectomy, has been rarely reported. We report two cases of thrombosis of the superior mesenteric vein after sleeve gastrectomy. It is confirmed by CT scan. Treatment is primarily medical. Three months later, the patients were asymptomatic still under antivitamin K. Thrombosis of the superior mesenteric vein after bariatric surgery is a diagnosis that one should know how to raise in front of any postoperative abdominal pain. The laparoscopic abdominal pressure (> 14 mm Hg), associated with a marked position in bariatric surgery, reduces the venous flow by 50% which may increase the risk of thrombosis. In addition, soft tissue trauma during surgery (manipulation of the small intestine during short gastric bypass or duodenal switch) releases tissue factors that could cause a mesenteric venous thrombosis in patients with a previously undiagnosed hypercoagulable state. The clinical signs of mesenteric venous ischemia are variable and nonspecific. The etiology of portal thrombosis must be done before the introduction of heparin therapy which is not always possible in emergency. An obese patient with a history of thrombosis should receive a complete etiology of these thromboses before bariatric surgery. Abnormal blood dirt, an active smoking fat woman having oral contraceptive, or a patient with a history of recurrent venous thrombosis may be a relative contraindication against a complex bariatric surgery with digestive bypass.