Abstract
Advantages of laparoscopic cholecystectomy are less patient discomfort and shorter hospital stay than with the traditional open approach. Nevertheless, this operation is performed under general anesthesia, using muscle relaxants and pneumoperitoneum, with most patients in the reverse Trendelenburg position. It has been shown that this procedure is associated with significant hypercoagulability and dilation of the veins of the leg. We review the role of these factors as potential risk factors for the development of postoperative venous thromboembolism and also report the rate of thromboembolic complications following laparoscopic cholecystectomy. Based on the available evidence, it is concluded that laparoscopic cholecystectomy, despite being a “minimally invasive procedure,” may be associated with a definite risk of developing postoperative venous thromboembolism that could extend beyond hospital discharge. Accordingly, thrombosis prophylaxis should be considered for these patients.
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References
Airan M, Appel M, Berci G, Coburg AJ, Cohen M, Cuschieri A, Dent T, Duppler D, Easter D, Greene F (1988) Retrospective and prospective multi-institutional laparoscopic cholecystectomy study organized by the Society of American Gastrointestinal Endoscopic Surgeons. Surg Endosc 6: 169–176
Arcelus JI, Traverso CI, Lopez-Cantarero M, Garcia JM, Navarro F, Gomez E, Bravo F (1988) Estudio de las modificaciones tromboelastográficas inducidas por la heparinización profiláctica en cirugía general. Cir Esp 43: 518–526
Arcelus JI, Caprini JA, Traverso CI (1991) International perspectives on venous thromboembolism prophylaxis in surgery. Semin Thromb Hemost 17: 322–325
Arcelus JI, Caprini JA (1993) Venous thromboembolism prevention after hospital discharge. In: Goldhaber SZ (ed) Venous thromboembolism. Marcel Dekker, New York, pp 497–518
Arcelus JI, Caprini JA, Traverso CI, Size G, Hasty JH (1993) The role of elastic compression stockings to prevent venous dilatation induced by a reverse Trendelenburg position. Phlebology 8: 111–115
Beebe DS, McNevin MP, Belani KJ, Letourneau JG, Crain MR, Goodale RL (1992) Evidence of venous stasis after abdominal insufflation for laparoscopic cholecystectomy. Anesthesiology 77 (3A): 148
Bergqvist D, Matzsch T, Jendteg S, Lindgren B, Persson U (1990) The cost-effectiveness of prevention of post-operative thromboembolism. Acta Chir Scand 156: 36–41
Bergqvist D (1990) Prophylaxis against postoperative venous thromboembolism—a survey of surveys. Thromb Haemorrh Disorders 2: 69–73
Blair SD, Menashi S, Samson D, Greenhalgh RM (1986) Can the hypercoagulability of surgery be measured? Br J Surg 73: 500
Caprini JA, Scurr JH, Hasty JH (1988) Role of compression modalities in a prophylactic program for deep vein thrombosis. Sem Thromb Hemost 14: 77–87
Caprini JA, Natonson RA (1989) Postoperative deep vein thrombosis: current clinical considerations. Semin Thromb Hemost 15: 8–13
Caprini JA, Arcelus JI, Hasty JH, Tamhane AC, Fabrega F (1991) Clinical assessment of venous thromboembolic risk in surgical patients. Sem Thromb Hemost 17: 304–312
Caprini JA, Arcelus JI, Traverso CI, Vittum D (1991) Hypercoagulability after laparscopic cholecystectomy. Thromb Haemost 65: 1347
Caprini JA, Arcelus JI, Traverso CI, Hasty JH (1991) Low molecular weight heparins and external pneumatic compression as options for venous thromboembolism prophylaxis. A surgeon's perspective. Semin Thromb Hemost 17: 356–366
Clagett GP, Reisch JS (1988) Prevention of Venous thromboembolism in general surgical patients. Ann Surg 208: 227–240
Colditz GA, Tuden RL, Oster G (1986) Rates of venous thrombosis after general surgery: combined results of randomised clinical trials. Lancet 2: 143–146
Coleridge-Smith PD, Hasty JH, Scurr JH (1990) Venous stasis and vein human changes during surgery. Br J Surg 77: 1055–1059
Coleridge-Smith PD, Hasty JH, Scurr JH (1991) Deep vein thrombosis: effect of graduated compression stockings on distension of the deep veins of the calf. Br J Surg 78: 724–726
Collins R, Scrimgeur A, Yusuf S, Peto R (1988) Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. N Engl J Med 318: 1162–1172
Conti S, Daschbach M (1982) Venous thromboembolism prophylaxis: a survey of its use in the United States. Arch Surg 117: 1036–1040
Cuschieri A, Berci G (1992) Laparoscopic biliary surgery. Blackwell, Oxford, pp 132–142
Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC (1993) Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 165: 9–14
Dubois F, Berthelot G, Levard H (1991) Laparoscopic cholecystectomy: historic perspective and personal experience. Surg Laparosc Endosc 1: 52–57
European Consensus Statement (1992) Prevention of venous thromboembolism. Int Angiol 11: 151–159
Haas S, Flosbach CW (1990) Prevention of postoperative thromboembolism in general surgery with enoxaparin: preliminary findings. Acta Chir Scand 156: 96–102
Hedlund PO, Blomback M (1979) The effect of prophylaxis with low dose heparin on blood coagulation parameters. A double blind study in connection with tranversical prostatectomy. Thromb Haemost 41: 337–344
Hoffman KN, Arcelus JI, Traverso CI, Caprini JA, Mattern T, Size GP, Peterson D, Laubach M (1993) Prevention of venous thromboembolism: results of a survey among North American surgeons. Thromb Haemost 69: 622
Huber O, Bounameaux H, Borts F (1992) Postoperative pulmonary embolism after hospital discharge. Arch Surg 127: 310–313
Hull RD, Raskob GE, Hirsh J (1986) Prophylaxis of venous thromboembolism. Chest 89: 374s-383s
Janssen HF, Schachner J, Hubbard J, Hartman JT (1987) The risk of deep venous thrombosis: a computerized epidemiologic approach. Surgery 101: 205–212
Jeffery PC, Nicolaides AN (1990) Graduated compression stockings in the prevention of postoperative deep vein thrombosis. Br J Surg 77: 380–383
Kemen M, Sperling H, Mumme A, Zumtobel V (1991) The thrombin-antithrombin III complex ELISA test in diagnosis of surgery-induced blood coagulation activation. Infusionstherapie 18: 199–201
Lassen MR, Borris LC, Christiansen HM, Schott P, Olsen AD, Sorensen JV, Rahr H, Jensen HP (1991) Clinical trials with low molecular weight heparins in the prevention of postoperative thromboembolic complications: a meta-analysis. Semin Thromb Hemost 17: 284–290
Lundqvist PB, Swedenborg J (1981) Postoperative hypercoagulability, detection and measurement using a modified recalcification time system, effects of low dose heparin and types of surgery. Thromb Hemost 46: 16
Millard JA, Hill BB, Cook P, Fenoglio ME (1991) Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis associated with pneumoperitoneum. 100th Scientific session of the Western Surgical Association, San Antonio, Texas, pp 32
Morgenstern L, Wong L, Berci G (1992) Twelve hundred cholecystectomies before the laparoscopic era. Arch Surg 127: 400–403
National Institutes of Health. Consensus Conference on prevention of venous thrombosis and pulmonary embolism (1986) JAMA 256: 744–748
National Institutes of Health. Consensus Conference on Gallstones and laparoscopic cholecystectomy (1993) JAMA 269: 1018–1024
Nicolaides AN, Irving D (1975) Clinical factors and the risk of deep venous thrombosis. In: Nicolaides AN editor Thromboembolism: aetiology, advanced in prevention and management. MTP, Lancaster, pp 193–204
Nicolaides AN, Fernandes E, Fernandes J, Pollock AV (1980) Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis and postoperative deep venous thrombosis. Surgery 87: 69–76
Ockelford PA, Patterson J, Johns AS (1989) A double blind randomized placebo controlled trial of thromboprophylaxis in major elective general surgery using once daily injections of low molecular weight heparin fragment (Fragmin). Thromb Haemost 62: 1046–1049
Peters JH, Gibbon GD, Innes JT, Nichols KE, Front ME, Roby SR, Ellison EC (1991) Complications of laparoscopic cholecystectomy. Surgery 110: 769–778
Pezzuoli G, Serneri GGN, Settembrini P, Coggi G, Olivari N, Buzzetti G, Chierichetti S, Scotti A, Scatigna M, Carnovali M (1989) Prophylaxis of fatal pulmonary embolism in general surgery using double-blind, randomized, controlled, clinical versus placebo (STEP). Int Surg 74: 205–210
Rodzynek JJ, Damien J, Huberty M (1984) Incidence of preoperative deep venous thrombosis in abdominal surgery. Br J Surg 71: 731–732
Sandler DA, Martin JF (1989) Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J Royal Soc Med 82: 203–206
Sandset PM, Hogevold HE, Lyberg T, Andersson TR, Abildgaard U (1989) Extrinsic pathway inhibitor in elective surgery: a comparison with other coagulation inhibitors. Thromb Haemost 62: 856–860
Schaub RD, Lynch PR, Stewart GJ (1978) The response of canine veins to three types of abdominal surgery: a scanning and transmission electron microscopic study. Surgery 83: 411–424
Scott TR, Zucker KA, Bailey RW (1992) Laparoscopic cholecystectomy: a review of 12,397 patients. Surg Laparoscop Endosc 2: 191–198
Scurr JH, Coleridge-Smith PD, Hasty JH (1988) Deep venous thrombosis: a continuing problem. BMJ 297: 28
Sripad S, Antcliff AC, Martin P (1971) Deep-vein thrombosis in two district hospitals in Essex. Br J Surg 58: 563–565
Stewart GJ, Lachman JW, Alburger PD, Ziskin MC, Philips CM, Jensen K (1990) Intraoperative venous dilation and subsequent development of deep vein thrombosis in patients undergoing total hip or knee replacement. Ultrasound Med Biol 16: 13–140
Summaria L, Caprini JA, McMillan R, Sandesara J, Alexrod CA, Mueller ME, Vagher JP, Walenga J, Fareed J (1988) Relationship between postsurgical fibrinolytic parameters and deep vein thrombosis in surgical patients treated with compression devices. Am Surg 54: 156–160
Tarnay TJ, Rohr PR, Davidson AG, Stevenson MM, Byars EF, Hopkins GR (1980) Pneumatic calf compression, fibrinolysis and the prevention of deep venous thrombosis. Surgery 88: 489–496
Traverso LW (1991) Laparoscopic cholecystectomy. Pract Gastroenterol 16: 16–27
Vitale GC, Collet D, Larson GM, Cheadle WG, Miller FB, Perissat J (1991) Interruption of professional and home activity after laparoscopic cholecystectomy among French and American patients. Am J Surg 161: 396–398
Wille-Jorgensen P (1991) Prophylaxis of postoperative thromboembolism with combined methods. Semin Thromb Hemost 17: 272–279
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Caprini, J.A., Arcelus, J.I. Prevention of postoperative venous thromboembolism following laparoscopic cholecystectomy. Surg Endosc 8, 741–747 (1994). https://doi.org/10.1007/BF00593432
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DOI: https://doi.org/10.1007/BF00593432