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Portomesenteric Vein Thrombosis in Patients Undergoing Sleeve Gastrectomy: an Updated Systematic Review and Meta-Analysis of 101,914 Patients

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Abstract

Introduction

Portomesenteric vein thrombosis (PMVT) is a rare but potentially fatal complication of sleeve gastrectomy (SG). The rising prevalence of SG has led to a surge in the occurrence of PMVT, while the associated risk factors have not been fully elucidated. This study aims to determine the incidence and risk factors of PMVT in patients undergoing SG.

Methods

A comprehensive literature search was performed in PubMed and EMBASE databases. Proportion and regression meta-analyses were conducted.

Results

In a total of 76 studies including 101,914 patients undergoing SG, we identified 357 patients with PMVT. Mean follow-up was 14.4 (SD: 16.3) months. The incidence of PMVT was found to be 0.50% (95%CI: 0.40–0.61%). The majority of the population presented with abdominal pain (91.8%) at an average of 22.4 days postoperatively and PMVT was mainly diagnosed with computed tomography (CT) (96.0%). Hematologic abnormalities predisposing to thrombophilia were identified in 34.9% of the population. Advanced age (p=0.02) and low center volume (p <0.0001) were significantly associated with PMVT, while gender, BMI, hematologic abnormality, prior history of deep vein thrombosis or pulmonary embolism, type of prophylactic anticoagulation, and duration of prophylactic anticoagulation were not associated with the incidence of PMVT in meta-regression analyses. Treatment included therapeutic anticoagulation in 93.4% and the mortality rate was 4/357 (1.1%).

Conclusion

PMVT is a rare complication of sleeve gastrectomy with an incidence rate <1% that is associated with low center volume and advanced age but is not affected by the duration or type of thromboprophylaxis administered postoperatively.

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Data Availability

All data are publicly available through the full texts of the previously published included studies. Access to Biorender.com and publishing rights of Graphical Abstract icons were kindly provided by Dr. Georgios Geropoulos, who has access on a paid subscription.

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Authors and Affiliations

  1. Department of Surgery, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health, Manhasset, NY, 11030, USA

    Dimitrios Giannis

  2. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA

    Dimitrios Giannis & Weiying Lu

  3. Western General Hospital, Edinburgh, EH4 2XU, UK

    Georgios Geropoulos

  4. Department of Transplant Surgery, Aristotle University of Thessaloniki School of Medicine, 54124, Thessaloniki, Greece

    Christos D Kakos

  5. Department of Clinical Neurosciences, Cambridge School of Medicine, Cambridge University, Cambridge, CB2 0QQ, UK

    Salim El Hadwe

  6. University College London School of Medicine, London, WC1E 6BT, UK

    Massimiliano Fornasiero

  7. Royal Infirmary Hospital, Edinburgh, EH16 4SA, UK

    Andrew Robertson

  8. Department of Surgery, Whittington Hospital, London, N19 5NF, UK

    Chetan Parmar

  9. Department of Surgery, UCLH, London, NW1 2BU, UK

    Chetan Parmar

  10. Apollo Hospitals, Research and Education Foundation, Delhi, 500096, India

    Chetan Parmar

Authors
  1. Dimitrios Giannis
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  2. Georgios Geropoulos
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  3. Christos D Kakos
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  4. Weiying Lu
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  5. Salim El Hadwe
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  6. Massimiliano Fornasiero
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  7. Andrew Robertson
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  8. Chetan Parmar
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Corresponding author

Correspondence to Dimitrios Giannis.

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Ethical Approval

The present study is a systematic review of previously published studies, and thus informed consent from patients and institutional review board approval were not required.

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Informed consent does not apply.

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Key Points

• The incidence of PMVT in patients undergoing SG was 0.50%

• Hematologic abnormalities (thrombophilia) are common in SG patients with PMVT

• Advanced age and low center volume were significantly associated with PMVT

• PMVT rate is not affected by the duration or type of postoperative thromboprophylaxis

Supplementary Information

ESM 1

Supplemental table 1. PRISMA checklist (DOCX 25 kb)

ESM 2

Supplemental table 2. Quality assessment of the included studies (DOCX 27 kb)

ESM 3

Supplemental table 3. Excluded studies meeting the inclusion criteria and reason for exclusion (DOCX 15 kb)

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Giannis, D., Geropoulos, G., Kakos, C.D. et al. Portomesenteric Vein Thrombosis in Patients Undergoing Sleeve Gastrectomy: an Updated Systematic Review and Meta-Analysis of 101,914 Patients. OBES SURG 33, 2991–3007 (2023). https://doi.org/10.1007/s11695-023-06714-z

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  • DOI: https://doi.org/10.1007/s11695-023-06714-z

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