AMA Publishing Group: Obesity Treatment Topic Collection

Portomesenteric Thrombosis Following Laparoscopic Bariatric Surgery Incidence, Patterns of Clinical Presentation, and Etiology in a Bariatric Patient Population Portomesenteric Thrombosis Following LBS

Goitein D, Matter I, Raziel A, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Objective

To describe the incidence of, the patterns of clinical presentation of, and the reasons for portomesenteric vein thrombosis among patients who underwent laparoscopic bariatric surgery.

Design

Retrospective, multicenter study.

Setting

Six academic bariatric centers.

Patients

Morbidly obese patients diagnosed with portomesenteric vein thrombosis following laparoscopic bariatric surgery between January 2007 and June 2012.

Main Outcome Measures

Clinical presentation, diagnostic measures used, treatments employed, outcome, and hematologic workup of patients.

Results

Of 5706 patients who underwent laparoscopic bariatric surgery, 17 (0.3%) had portomesenteric vein thrombosis, 16 after sleeve gastrectomy and 1 following adjustable gastric banding. Seven patients were women, the mean age was 38 years, and the mean body mass index was 44.3. The median time to presentation was 10.1 days, and the median time to diagnosis was 11.7 days. New-onset epigastric pain was present in all patients, whereas other signs and symptoms were sporadically found. Computed tomography was performed and was diagnostic in 16 cases. Ultrasonography was used for 9 patients, and positive results were found for 8 of these patients. Patients were treated by anticoagulation with subcutaneous low-molecular-weight heparin (n = 15) or intravenous heparin (n = 2), followed by warfarin sodium. One patient underwent transhepatic portal infusion of streptokinase. Three patients required surgery: laparoscopic splenectomy due to infarct and abscess for 1 patient and laparotomy for 2 patients (with necrotic small-bowl resection for 1 of these patients). There were no deaths.

Conclusions

Portomesenteric vein thrombosis is rare after laparoscopic bariatric surgery. Familiarity with this dangerous entity is important. Prompt diagnosis and care, initiated by a high index of suspicion, is crucial.

Why Isn't Bariatric Surgery for Adolescents Catching On? Bariatric Surgery for Adolescents

Steele K. — Mon, 01 Apr 2013 00:00:00 GMT

Objectives:

To determine the current rate of inpatient bariatric surgical procedures among adolescents and to analyze national trends of use from 2000 to 2009.

Design:

Retrospective cross-sectional study.

Setting:

Discharge data obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database, 2000 through 2009.

Participants:

Adolescents (defined herein as individuals aged 10-19 years) undergoing inpatient bariatric procedures.

Intervention:

Inpatient bariatric surgery.

Main Outcome Measures:

The primary outcome measure was the national population-based bariatric procedure rate. The secondary outcome measures were trends in procedure rates and type, demographics, complication rate, length of stay, and hospital charges from 2000 through 2009.

Results:

The inpatient bariatric procedure rate increased from 0.8 per 100 000 in 2000 to 2.3 per 100 000 in 2003 (328 vs 987 procedures) but did not change significantly in 2006 (2.2 per 100 000) or 2009 (2.4 per 100 000), with 925 vs 1009 procedures. The use of laparoscopic adjustable gastric banding approached one-third (32.1%) of all procedures by 2009. The cohort was predominantly female and older than 17 years. The prevalence of comorbidities increased from 2003 (49.3%) to 2009 (58.6%) (P = .002), while the complication rate remained low and the in-hospital length of stay decreased by approximately 1 day (P < .001). Increasing numbers of patients had Medicaid as their primary payer source; however, most (68.3% in 2009) had private insurance.

Conclusions:

Despite the worsening childhood obesity epidemic, the rate of inpatient bariatric procedures among adolescents has plateaued since 2003. The predominant procedure type has changed to minimally invasive techniques, including laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Trends show low complication rates and decreasing length of stay, despite increasing comorbid conditions among patients.