Background

Portomesenteric vein thrombosis (PMVT) is a known complication after laparoscopic sleeve gastrectomy (LSG). Previous studies have indicated that many of these patients may have an undiagnosed thrombophilia. We recently changed our practice to check thrombophilia panel on every patient preoperatively undergoing LSG. The purpose of this study is to 1) estimate the prevalence of thrombophilia in patients seeking LSG and 2) determine if extended chemoprophylaxis post-LSG reduces PMVT.

Methods

Thrombophilia panels were drawn on every patient seeking LSG after July 2018 at two high-volume bariatric surgery centers. A positive thrombophilia panel included: Factor VIII>150%, Protein C<70%, Protein S<55%, and Anti-thrombin<83%. Patients with positive thrombophilia panel were discharged on extended chemoprophylaxis. PMVT rates for all LSG performed from Jan 2014 thru July 2018 (no routine preop thrombophilia panel) were compared to PMVT rates after July thru March 2019 (routine preop thrombophilia panel).

Results

1075 patients seeking LSG had thrombophilia panel checked preoperatively. The cohort was 83% female, 84% Hispanic and 15% non-Hispanic African American; mean age and BMI were 39.2 years and 43 kg/m2, respectively. 577/1075 (54%) had abnormal thrombophilia panel preoperatively, including Factor VIII elevation (89.4%), Anti-thrombin III deficiency (5.9%), Protein S deficiency (2.9%), and Protein C deficiency (2.5%). Between January 2014 and July 2018, 18 PMVT were diagnosed among 4228 LSG (0.4%). After July 2018, 1 PMVT was diagnosed among 745 LSG (0.1%) who had thrombophilia panel checked preoperatively.

Conclusions

The estimated prevalence of thrombophilia is 54% in this patient population. Extended prophylaxis may decrease PMVT post-LSG.