Portomesentric and splenic vein thrombosis (PMSVT) after bariatric surgery: a systematic review of 110 patients

Missing something? A scoping review of venous thromboembolic events and their associations with bariatric surgery. Refining the evidence base

“…In 2014, SG was the most performed BS, comprising >50% of all primary BS in 2016, and had the highest increase rates in recent years [ 36 , 77 , 78 ]. Post-SG PMVT incidence is 0.37%–1% and is increasing with SG's popularity [ 79 ]; and a 0.1%–1.81% PMVT incidence has been observed post-BS including laparoscopic BS [ [80] , [81] , [82] ]. Research has reported a 1.61% PMVT mortality rate [ 82 ].…”

Portomesenteric and splenic vein thrombosis after laparoscopic sleeve gastrectomy

“…Portomesenteric venous thrombosis is a rare but potentially life-threatening condition after laparoscopic surgery. [4][5][6] Postoperative PVT cases have become frequent with the widespread use of laparoscopic bariatric surgical procedures in recent years. Commonly reported complications of laparoscopic sleeve gastrectomy (LSG) include stapler line leak, respiratory failure, pulmonary embolism, hemorrhage, stricture, and splenic injury while the number of reported PVT cases is limited.…”

“…Therefore, PVT after laparoscopic splenectomy has been evaluated separately from other laparoscopic surgical procedures. [6] The ligation of the splenic vein causes endothelial damage, which increases the thrombogenicity of this vessel. In sleeve gastrectomy, only short gastric veins are dissected, without direct dissections of portomesentlric vessels.…”

“…Although the mechanism of PVT formation after laparoscopy is unknown, it has been suggested that the increase in intraabdominal pressure due to pneumoperi-toneum might have led to a decrease in portal venous blood flow, which in turn led to a relative prothrombotic state. [6,7] Laparoscopic sleeve gastrectomy (LSG) is a popular single-stage operation in the treatment of morbid obesity with acceptable morbidity and long-term weight loss prospect compared to Roux-enY gastric bypass. [8] Here we present the case of a 27 year-old male patient who had LSG and developed thrombosis in portal vein, superior mesenteric vein, and splenic vein on postoperative day 41 along with literature review.…”

FSRH Guideline (April 2019) Overweight, Obesity and Contraception

“…Two retrospective cohort studies reporting on very small numbers of patients with portomesenteric vein thrombosis (n=17 and n=5) after laparoscopic sleeve gastrectomy256,257 reported OC use (unspecified type) in some patients with this complication (n=7 and n=1, respectively), but also no contraceptive use or contraceptive implant use in others. A 2018 systematic review and meta-analysis258 on portomesenteric vein thrombosis after a bariatric procedure included 41 studies with a total of 110 patients. None of these studies were designed to look at contraceptive safety; all had very small numbers and no meaningful contraceptive comparison groups, and were conducted in a population at high risk for thrombotic events irrespective of contraceptive use, so these data are generally uninformative.…”