Assessing risk factors, presentation, and management of portomesenteric vein thrombosis after sleeve gastrectomy: A multicenter case-control study

Rena C. Moon, Muhammad Ghanem, Andre F. Teixeira, Nestor de la Cruz-Munoz, Meredith K. Young, Patrick Domkowski, Jason Radecke, Stephen G. Boyce, Raul Rosenthal, Emmanuel Lo Menzo, David Gutierrez Blanco, David R. Funes, Muhammad A. Jawad

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Portomesenteric vein thrombosis (PMVT) is a rare complication of laparoscopic sleeve gastrectomy. Objectives: To identify incidence, patient factors, diagnosis, and treatment of PMVT after laparoscopic sleeve gastrectomy in a large administrative data registry. Setting: Academic Hospitals and Private Practices, United States. Methods: A retrospective chart review of 5538 sleeve gastrectomy patients between January 1, 2008 and September 30, 2016 was performed at 5 bariatric centers in the United States. A total of 11 patients were identified as developing PMVT, and 3 controls for each patient were selected by matching age, sex, preoperative body mass index, and center. Results: After adjusting for confounding variables, 2 patient factors significantly impacted the risk of PMVT after sleeve gastrectomy including personal history of malignancy (odds ratio 62, 95% confidence interval (CI) 1.4-99.9), and type 2 diabetes (odds ratio 12.7, 95% CI 1.2-137.3) compared with controls. Mean period from laparoscopic sleeve gastrectomy to presentation of PMVT was 19.3 ± 15.11 days (range, 8-62). All patients except 1 complained of abdominal pain as the main presenting symptom. Other complaints included nausea and vomiting, no bowel movement, decreased appetite, diarrhea, and dehydration, and leukocytosis was present in 45.5% of the patients. All diagnoses were made by using computed tomography. All initial treatments were anticoagulation, heparin drip being the most common method (90.9%). Of patients, 9 (81.8%) required a secondary anticoagulation therapy, and 1 (9.1%) patient required a reoperation. Conclusion: Incidence of PMVT is low after sleeve gastrectomy. A personal history of malignancy and type 2 diabetes increase the risk of PMVT. Increasing abdominal pain in a context of dehydration is common presenting symptoms with diagnosis confirmed by computed tomography. Anticoagulation is the standard treatment. There was no mortality associated with the occurrence of PMVT in this cohort.

Original languageEnglish (US)
JournalSurgery for Obesity and Related Diseases
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Risk Management
Gastrectomy
Case-Control Studies
Veins
Thrombosis
Dehydration
Type 2 Diabetes Mellitus
Abdominal Pain
Odds Ratio
Tomography
Confidence Intervals
Bariatrics
Confounding Factors (Epidemiology)
Private Practice
Incidence
Leukocytosis
Appetite
Therapeutics
Reoperation
Nausea

Keywords

  • Portal vein thrombosis
  • Portomesenteric vein thrombosis
  • Risk factors
  • Sleeve gastrectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Assessing risk factors, presentation, and management of portomesenteric vein thrombosis after sleeve gastrectomy : A multicenter case-control study. / Moon, Rena C.; Ghanem, Muhammad; Teixeira, Andre F.; de la Cruz-Munoz, Nestor; Young, Meredith K.; Domkowski, Patrick; Radecke, Jason; Boyce, Stephen G.; Rosenthal, Raul; Menzo, Emmanuel Lo; Blanco, David Gutierrez; Funes, David R.; Jawad, Muhammad A.

In: Surgery for Obesity and Related Diseases, 01.01.2017.

Research output: Contribution to journalArticle

Moon, Rena C. ; Ghanem, Muhammad ; Teixeira, Andre F. ; de la Cruz-Munoz, Nestor ; Young, Meredith K. ; Domkowski, Patrick ; Radecke, Jason ; Boyce, Stephen G. ; Rosenthal, Raul ; Menzo, Emmanuel Lo ; Blanco, David Gutierrez ; Funes, David R. ; Jawad, Muhammad A. / Assessing risk factors, presentation, and management of portomesenteric vein thrombosis after sleeve gastrectomy : A multicenter case-control study. In: Surgery for Obesity and Related Diseases. 2017.
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abstract = "Background: Portomesenteric vein thrombosis (PMVT) is a rare complication of laparoscopic sleeve gastrectomy. Objectives: To identify incidence, patient factors, diagnosis, and treatment of PMVT after laparoscopic sleeve gastrectomy in a large administrative data registry. Setting: Academic Hospitals and Private Practices, United States. Methods: A retrospective chart review of 5538 sleeve gastrectomy patients between January 1, 2008 and September 30, 2016 was performed at 5 bariatric centers in the United States. A total of 11 patients were identified as developing PMVT, and 3 controls for each patient were selected by matching age, sex, preoperative body mass index, and center. Results: After adjusting for confounding variables, 2 patient factors significantly impacted the risk of PMVT after sleeve gastrectomy including personal history of malignancy (odds ratio 62, 95{\%} confidence interval (CI) 1.4-99.9), and type 2 diabetes (odds ratio 12.7, 95{\%} CI 1.2-137.3) compared with controls. Mean period from laparoscopic sleeve gastrectomy to presentation of PMVT was 19.3 ± 15.11 days (range, 8-62). All patients except 1 complained of abdominal pain as the main presenting symptom. Other complaints included nausea and vomiting, no bowel movement, decreased appetite, diarrhea, and dehydration, and leukocytosis was present in 45.5{\%} of the patients. All diagnoses were made by using computed tomography. All initial treatments were anticoagulation, heparin drip being the most common method (90.9{\%}). Of patients, 9 (81.8{\%}) required a secondary anticoagulation therapy, and 1 (9.1{\%}) patient required a reoperation. Conclusion: Incidence of PMVT is low after sleeve gastrectomy. A personal history of malignancy and type 2 diabetes increase the risk of PMVT. Increasing abdominal pain in a context of dehydration is common presenting symptoms with diagnosis confirmed by computed tomography. Anticoagulation is the standard treatment. There was no mortality associated with the occurrence of PMVT in this cohort.",
keywords = "Portal vein thrombosis, Portomesenteric vein thrombosis, Risk factors, Sleeve gastrectomy",
author = "Moon, {Rena C.} and Muhammad Ghanem and Teixeira, {Andre F.} and {de la Cruz-Munoz}, Nestor and Young, {Meredith K.} and Patrick Domkowski and Jason Radecke and Boyce, {Stephen G.} and Raul Rosenthal and Menzo, {Emmanuel Lo} and Blanco, {David Gutierrez} and Funes, {David R.} and Jawad, {Muhammad A.}",
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T1 - Assessing risk factors, presentation, and management of portomesenteric vein thrombosis after sleeve gastrectomy

T2 - A multicenter case-control study

AU - Moon, Rena C.

AU - Ghanem, Muhammad

AU - Teixeira, Andre F.

AU - de la Cruz-Munoz, Nestor

AU - Young, Meredith K.

AU - Domkowski, Patrick

AU - Radecke, Jason

AU - Boyce, Stephen G.

AU - Rosenthal, Raul

AU - Menzo, Emmanuel Lo

AU - Blanco, David Gutierrez

AU - Funes, David R.

AU - Jawad, Muhammad A.

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Y1 - 2017/1/1

N2 - Background: Portomesenteric vein thrombosis (PMVT) is a rare complication of laparoscopic sleeve gastrectomy. Objectives: To identify incidence, patient factors, diagnosis, and treatment of PMVT after laparoscopic sleeve gastrectomy in a large administrative data registry. Setting: Academic Hospitals and Private Practices, United States. Methods: A retrospective chart review of 5538 sleeve gastrectomy patients between January 1, 2008 and September 30, 2016 was performed at 5 bariatric centers in the United States. A total of 11 patients were identified as developing PMVT, and 3 controls for each patient were selected by matching age, sex, preoperative body mass index, and center. Results: After adjusting for confounding variables, 2 patient factors significantly impacted the risk of PMVT after sleeve gastrectomy including personal history of malignancy (odds ratio 62, 95% confidence interval (CI) 1.4-99.9), and type 2 diabetes (odds ratio 12.7, 95% CI 1.2-137.3) compared with controls. Mean period from laparoscopic sleeve gastrectomy to presentation of PMVT was 19.3 ± 15.11 days (range, 8-62). All patients except 1 complained of abdominal pain as the main presenting symptom. Other complaints included nausea and vomiting, no bowel movement, decreased appetite, diarrhea, and dehydration, and leukocytosis was present in 45.5% of the patients. All diagnoses were made by using computed tomography. All initial treatments were anticoagulation, heparin drip being the most common method (90.9%). Of patients, 9 (81.8%) required a secondary anticoagulation therapy, and 1 (9.1%) patient required a reoperation. Conclusion: Incidence of PMVT is low after sleeve gastrectomy. A personal history of malignancy and type 2 diabetes increase the risk of PMVT. Increasing abdominal pain in a context of dehydration is common presenting symptoms with diagnosis confirmed by computed tomography. Anticoagulation is the standard treatment. There was no mortality associated with the occurrence of PMVT in this cohort.

AB - Background: Portomesenteric vein thrombosis (PMVT) is a rare complication of laparoscopic sleeve gastrectomy. Objectives: To identify incidence, patient factors, diagnosis, and treatment of PMVT after laparoscopic sleeve gastrectomy in a large administrative data registry. Setting: Academic Hospitals and Private Practices, United States. Methods: A retrospective chart review of 5538 sleeve gastrectomy patients between January 1, 2008 and September 30, 2016 was performed at 5 bariatric centers in the United States. A total of 11 patients were identified as developing PMVT, and 3 controls for each patient were selected by matching age, sex, preoperative body mass index, and center. Results: After adjusting for confounding variables, 2 patient factors significantly impacted the risk of PMVT after sleeve gastrectomy including personal history of malignancy (odds ratio 62, 95% confidence interval (CI) 1.4-99.9), and type 2 diabetes (odds ratio 12.7, 95% CI 1.2-137.3) compared with controls. Mean period from laparoscopic sleeve gastrectomy to presentation of PMVT was 19.3 ± 15.11 days (range, 8-62). All patients except 1 complained of abdominal pain as the main presenting symptom. Other complaints included nausea and vomiting, no bowel movement, decreased appetite, diarrhea, and dehydration, and leukocytosis was present in 45.5% of the patients. All diagnoses were made by using computed tomography. All initial treatments were anticoagulation, heparin drip being the most common method (90.9%). Of patients, 9 (81.8%) required a secondary anticoagulation therapy, and 1 (9.1%) patient required a reoperation. Conclusion: Incidence of PMVT is low after sleeve gastrectomy. A personal history of malignancy and type 2 diabetes increase the risk of PMVT. Increasing abdominal pain in a context of dehydration is common presenting symptoms with diagnosis confirmed by computed tomography. Anticoagulation is the standard treatment. There was no mortality associated with the occurrence of PMVT in this cohort.

KW - Portal vein thrombosis

KW - Portomesenteric vein thrombosis

KW - Risk factors

KW - Sleeve gastrectomy

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