Elsevier

Surgery for Obesity and Related Diseases

Volume 8, Issue 1, January–February 2012, Pages 108-115
Surgery for Obesity and Related Diseases

Review article
Venous thromboembolism after laparoscopic bariatric surgery for morbid obesity: clinical burden and prevention

https://doi.org/10.1016/j.soard.2011.09.005Get rights and content

Abstract

Background

The clinical benefit of prophylaxis for venous thromboembolism (VTE) in laparoscopic bariatric surgery is unclear. Our objective was to assess the clinical burden of VTE after laparoscopic bariatric surgery.

Methods

We performed a systematic review and meta-analysis. Studies were considered for the review if they reported on the methods used for antithrombotic prophylaxis and on the incidence of objectively confirmed VTE in patients who had undergone laparoscopic bariatric surgery.

Results

Overall, 19 studies were included in the analysis. The weighted mean incidence (WMI) of pulmonary embolism was .5% (12 events in 3991 patients, 12 studies; 95% confidence interval [CI] .2–.9%; I2 38%) with unfractionated heparin (5000 UI twice or 3 times daily) or low-molecular-weight heparin (30 mg twice daily or 40 mg once daily). The WMI of major bleeding as originally reported in 7 of these studies was 3.6% (2741 patients; 95% CI .9–7.95; I2 94%). The WMI of screened VTE in 3 high-quality studies with different regimens of heparin prophylaxis was 2.0% (8 events in 458 patients; 95% CI .9–3.5%; I2 0%). The WMI of symptomatic VTE was .6% (4 studies; 7 events in 1328 patients; 95% CI .3–1.1%; I2 0%) and that of major bleeding was 2.0% (95% CI 1.0–3.4%; I2 55%), with weight-adjusted doses of heparin prophylaxis.

Conclusion

The rate of VTE after laparoscopic bariatric surgery seems to be relatively low with standard regimens for antithrombotic prophylaxis. The incidence of major bleeding seems to increase using weight-adjusted doses of heparin with no advantage in terms of VTE reduction.

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.

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