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Postoperative Portomesenteric Venous Thrombosis: Lessons Learned From 1,069 Consecutive Laparoscopic Colorectal Resections

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Abstract

Background

Portomesenteric venous thrombosis (PVT) is a known complication after open and laparoscopic colorectal (LCR) surgery. Risk factors and the prognosis of PVT have been poorly described.

Methods

This study is a retrospective analysis of a prospectively collected database. Patients with new-onset postoperative abdominal pain were evaluated with a computed tomography scan of the abdomen. Patients found to have PVT were analyzed. A multivariate analysis was performed to identify predictors of PVT.

Results

A total of 1,069 patients undergoing LCR surgery for inflammatory bowel disease (IBD) or nonmetastatic cancer between June 2002 and June 2012 were included. Altogether, 37 (3.5 %) patients experienced symptomatic postoperative PVT. On univariate analysis, IBD (p < 0.001), ulcerative colitis (p = 0.016), preoperative therapy with steroids (p = 0.008), operative time ≥220 min (p = 0.004), total proctocolectomy (TPC) (p < 0.001), ileoanal pouch anastomosis (p = 0.006), and postoperative intraabdominal septic complications (p < 0.001) were found to be significant risk factors. By multivariate analysis, TPC (p = 0.026) and postoperative intraabdominal septic complications (p < 0.001) were independent predictors of PVT. In the PVT group, postoperative length of stay was longer (14.8 vs. 7.4 days, p < 0.001). Of the patients evaluated with a hematologic workup, 72.7 % were found to have a hypercoagulable condition. All patients were managed with oral anticoagulation for at least 6 months. No death or complications related to PVT occurred.

Conclusions

PVT is a potentially serious complication that is more likely to occur after TPC and in the presence of postoperative intraabdominal septic complications, particularly in patients with a coagulation disorder. Prompt diagnosis and treatment with oral anticoagulation are recommended to avoid long-term sequelae.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, University of Chicago Medical Center, MC 5095, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA

    Marco E. Allaix, Mukta K. Krane, Marco Zoccali, Konstantin Umanskiy & Roger Hurst

  2. Department of Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Box 356410, Seattle, WA, 98195, USA

    Alessandro Fichera

Authors
  1. Marco E. Allaix
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  2. Mukta K. Krane
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  3. Marco Zoccali
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  4. Konstantin Umanskiy
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  5. Roger Hurst
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  6. Alessandro Fichera
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Corresponding author

Correspondence to Marco E. Allaix.

Additional information

This presentation was selected for the Grassi Prize session at the ISW 2013, Helsinki, 24–29 August 2013.

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Allaix, M.E., Krane, M.K., Zoccali, M. et al. Postoperative Portomesenteric Venous Thrombosis: Lessons Learned From 1,069 Consecutive Laparoscopic Colorectal Resections. World J Surg 38, 976–984 (2014). https://doi.org/10.1007/s00268-013-2336-7

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