Review articleVenous thromboembolism after laparoscopic bariatric surgery for morbid obesity: clinical burden and prevention
Section snippets
Methods
The protocol for the present review was defined by detailing the specific study objectives, criteria for study selection and assessment of study quality, study outcomes, and statistical methods.
Results
The computerized search for “venous thrombosis AND laparoscopic bariatric surgery” OR “venous thromboembolism AND laparoscopic bariatric surgery” identified 129 potentially eligible reports overall. Of these studies, 93 were excluded after screening the titles and abstracts using the predefined inclusion and exclusion criteria. The remaining 36 studies were retrieved for full text examination. Of these, 20 were excluded because they were studies of open surgery (n = 11), did not provide
Discussion
The present systematic review shows that the incidence of pulmonary embolism after laparoscopic bariatric surgery for morbid obesity is <1%, regardless of the regimen used for antithrombotic prophylaxis. When an objective test was used to screen for asymptomatic deep vein thrombosis, the reported incidence of postoperative VTE in this setting was about 2%. The rate of postoperative VTE observed in our analysis after laparoscopic bariatric surgery is consistent with the results of recently
Conclusion
The present systematic review has shown that limited evidence is currently available on the use of antithrombotic prophylaxis after laparoscopic bariatric surgery for morbid obesity. The incidence of postoperative VTE seems to be relatively low in this setting, and the benefit of weight-adjusted heparin prophylaxis remains controversial. Overall, our review highlights the need for randomized studies with time-scheduled screening for VTE and standardized criteria for defining bleeding
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
References (37)
- et al.
Pulmonary embolism complicating bariatric surgery: detailed analysis of a single institution's 24-year experience
J Am Coll Surg
(2006) - et al.
Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh
Am J Surg
(1996) - et al.
Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients
J Thromb Haemost
(2010) Evaluation of the learning curve for laparoscopic Roux-en-Y gastric bypass surgery
Surg Obes Relat Dis
(2005)- et al.
Cardiorespiratory fitness and short-term complications after bariatric surgery
Chest
(2006) - et al.
Best Poster Award: a comparison of thromboembolic and bleeding events following laparoscopic gastric bypass in patients treated with prophylactic regimens of unfractionated heparin or enoxaparin
Am J Surg
(2007) - et al.
Incidence of deep vein thrombosis in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass
Surg Obes Relat Dis
(2008) - et al.
Enoxaparin thromboprophylaxis in gastric bypass patients: extended duration, dose stratification and antifactor Xa activity
Surg Obes Relat Dis
(2008) - et al.
Pharmacologic prophylaxis against venous thromboembolic complications is not mandatory for all laparoscopic Roux-en-Y gastric bypass procedures
J Am Coll Surg
(2009) - et al.
Extended thromboprophylaxis reduces incidence of postoperative venous thromboembolism in laparoscopic bariatric surgery
Surg Obes Relat Dis
(2010)