Background

Venous thromboembolism (VTE), including portomesenteric vein thrombosis (PMVT), is a major complication of laparoscopic sleeve gastrectomy (LSG). We changed our practice in July 2021 to routinely discharge all LSG patients postoperatively with extended chemoprophylaxis. The objective of this study is to evaluate the efficacy/safety of routine extended chemoprophylaxis for LSG patients compared to two previous timeframes utilizing selective extended chemoprophylaxis.

Methods

Between 2012-2018, LSG patients were discharged on extended chemoprophylaxis if deemed “high-risk” for VTE, including patients with BMI >50, and previous VTE (Group 1). Between 2018-2021, extended chemoprophylaxis was broadened to positive preoperative thrombophilia panels (including Factor VIII) (Group 2). After 2021, all LSG were routinely discharged on extended chemoprophylaxis (Group 3). The regimen was 30 days Lovenox BID (weight-based dosing). Outcomes evaluated were rate of VTE/PMVT and post-operative bleed, including delayed bleed (readmission for bleed).

Results

A total of 8864 patients underwent LSG. Average age and BMI were 37.5 years and 43.0 kg/m2, respectively. Overall incidence of PVT was 33/8864 (0.34%). Table 1 demonstrates that converting from selective extended chemoprophylaxis (Group 1) to routine extended chemoprophylaxis (Group 3) decreased the rate of PMVT from 0.55% to 0.21%. There was a slightly higher overall bleeding rate (0.44%), including delayed bleeds (0.10%) in the routine extended chemoprophylaxis patients (Group 3). The majority of these delayed bleeds were managed non-operatively.

Conclusions

Routine extended chemoprophylaxis for all LSG may reduce PMVT rate but lead to a slightly higher bleeding rate postoperatively.