Venous Thromboembolism in Bariatric Surgery

Abstract

Deep venous thrombosis (DVT) and pulmonary embolism (PE) constitute clinical presentations of the same vascular disease, known as venous thromboembolism (VTE). VTE is responsible for hospitalization of >250000 Americans annually. It is associated with high morbidity and mortality and represents a primary cause of preventable death. There is strong evidence that obesity is an independent risk factor for DVT and PE. Bariatric surgery is proven to be an effective means in the therapy of morbid obesity and its related comorbidities, thus its prevalence is rapidly increasing. Well established and widely performed procedures include laparoscopic adjustable gastric band (LAGB), Roux-en-Y gastric bypass (RYGBP), biliopancreatic diversion (BPD, with or without duodenal switch) and sleeve gastrectomy (SG). LAGB is a purely restrictive method, while RYGBP and BPD are considered as mainly malabsorbptive procedures. SG was performed as a bridge to further by-pass surgery, however nowadays is performed as a single stage procedure. The risk of VTE in patients undergoing elective bariatric surgery is high, attributable to obesity, intraoperating factors and the lack of an established guidance describing optimal VTE prophylaxis. Overall incidence of VTE in this population is reported to be 1-3%. Diagnosis of PE postoperatively in obese patients can be difficult due to physical limitations and consequently may be underdiagnosed. Furthermore, although VTE is usually diagnosed as immediate postoperative complication, PE can occur in nonhospitalized patients, within the first month after surgery, despite pharmacologic prophylaxis.

Cite this paper

@inproceedings{Zachari2012VenousTI, title={Venous Thromboembolism in Bariatric Surgery}, author={Eleni Zachari and Eleni Sioka and George Tzovaras}, year={2012} }