Background

Portomesenteric vein thrombosis (PMVT) is a significant post-operative complication after laparoscopic sleeve gastrectomy (LSG). This study provides long-term follow up of patients who developed PMVT postoperatively and insight into various treatment strategies.

Methods

A retrospective review was performed of LSG patients who developed PMVT postoperatively over a 10 year period. Imaging was obtained to determine clot resolution vs. cavernous transformation of the portal vein. Duration of anticoagulation and any additional intervention was documented.

Results

From 2012-2022, 33 patients developed PMVT after LSG. During this time 8864 LSG were performed (0.37% incidence). Mean age and BMI were 37 years and 41 kg/m2, respectively. Most (85%) were female. 75% had a positive thrombophilia workup. Most (82%) were diagnosed within 30 days postoperatively. 52% involved the portal vein and the superior mesenteric vein, 6% involved secondary branches of the portal vein. All patients were started on therapeutic anticoagulation (AC). 59% continued AC beyond 6 months, 2 patients underwent open thrombectomy and 2 patients underwent portal vein recanalization. At median follow-up of 3 years, 9/33 PMVT (27%) resolved, 14/33 (42%) have continued thrombus, and 10/33 (30%) progressed to cavernous transformation of the portal vein. The latter group had extensive clot burden at the initial diagnosis.

Conclusions

PMVT is a significant but infrequent (0.37%) complication of LSG. Consideration should be given to early intervention (either surgical or radiologic) especially in those with extensive clot burden to decrease the risk of progression to cavernous transformation. Anticoagulation should be continued until the thrombus has resolved radiographically.