Laparoscopic sleeve gastrectomy (LSG) is nowadays the most popular bariatric procedure for obesity. However, whether LSG increases the risk of thrombosis remains unclear. The aim of this study was to investigate potential effects of LSG on coagulation system.
Fifty-five obese patients underwent LSG between 2016 and 2018. The LSG was performed with pneumoperitoneum pressure maintained at 13 mmHg. Venous blood specimens were collected from each patient before surgery, at the end of pneumoperitoneum (i.e., 0 h after surgery), and at 24 h after surgery to determine prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), platelet count (PLT), D-dimer (D-D), red blood cell count (RBC), hematocrit (HCT), plateletcrit (PCT), cholesterol (CHOL), triglyceride (TRIG), and serum calcium (Ca). All patients were examined on the veins of the lower limbs by color Duplex sonography (CDS) before surgery and at 24 h after surgery, respectively.
All patients successfully underwent LSG. No severe surgery-related complications were observed during 1-month follow-up after operation. Preoperative BMI was 43.6 ± 8.3 kg/m2. The levels of coagulation factors were within the normal range before surgery, except a relatively higher PLT. The PT and D-D were increased at 0 h and 24 h after surgery (P < 0.05), whereas APTT was decreased (P < 0.05). The postoperative FIB remained similar to the preoperative one (P > 0.05). The CDS identified no thrombus in the veins of the lower limbs, either before surgery or at 24 h after surgery.
LSG may cause postoperative hypercoagulability of patients with obesity.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Rottenstreich A, Elazary R, Yuval JB, et al. Assessment of the procoagulant potential after laparoscopic sleeve gastrectomy: a potential role for extended thromboprophylaxis. Surg Obes Relat Dis. 2018;14:1–7.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. Jama. 2004;292:1724–37.
Terranova L, Busetto L, Vestri A, et al. Bariatric Surgery: cost-effectiveness and budget impact. Obes Surg. 2012;22:646–53.
Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28(12):3783–94.
Liu J. The status quo and changes of metabolic and bariatric surgery in China. Chinese Journal of Gastrointestinal Surgery. 2017;20(4):378–82.
Abuoglu HH, Müftüoğlu MAT, Odabaşı M. A new protocol for venous thromboembolism prophylaxis in bariatric surgery. Obes Surg. 2019;29(2):729–34.
Davies HO, Popplewell M, Singhal R, et al. Obesity and lower limb venous disease—the epidemic of phlebesity. Phlebology. 2017;32(4):227–33.
Cheung ZB, Vig KS, White SJW, et al. Impact of obesity on surgical outcomes following laminectomy for spinal metastases. Global Spine J. 2019;9(3):254–9.
Kimura Y, Oki E, Ando K, et al. Incidence of venous thromboembolism following laparoscopic surgery for gastrointestinal cancer: a single-center. Prospective Cohort Study World J Surg. 2016;40(2):309–14.
Nimeri AA, Bautista J, Ibrahim M, et al. Mandatory risk assessment reduces venous thromboembolism in bariatric surgery patients. Obes Surg. 2018;28(2):541–7.
Kahn SR, Morrison DR, Cohen JM, Emed J, Tagalakis V, Roussin A, et al. Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database Syst Rev (7):2013:CD008201.
Spyropoulos AC, Lin J. Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations. J Manag Care Pharm. 2007;13:475–86.
Sczepaniak JP, Owens ML, Shukla H, et al. Comparability of weight loss reporting after gastric bypass and sleeve gastrectomy using BOLD data 2008-2011. Obes Surg. 2015;25(5):788–95.
Carlin AM, Zeni TM, English WJ, et al. The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Ann Surg. 2013;257(5):791–7.
Ching SS, Cheng AKS, Kong LWC, et al. Early outcomes of laparoscopic sleeve gastrectomy in a multiethnic Asia in cohort. Surg Obes Relat Dis. 2015;12(2):335–7.
Alvarenga ES, Menzo EL, Szomstein S, et al. Safety and efficacy of 1020 consecutive laparoscopic sleeve gastrectomies performed as a primary treatment modality for morbid obesity. A single-center experience from metabolic and bariatric surgical accreditation quality and improvement program. Surg Endosc. 2016;30(7):2673–8.
Berger R, Clements RH, Morton JM, et al. The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: the first report from the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP). Ann Surg. 2016;264(3):464–73.
Ponce J, Nguyen NT, Hutter M, et al. American Society for Metabolic and Bariatric Surgery estimation of surgery procedures in the United States, 2011–2014. Surg Obes Relat Dis. 2015;11:1199–200.
Bariatric Surgical Group, Shanghai Surgical Association, Shanghai Quality Control Center of General Surgery. Bariatric/metabolic surgery annual research and trend analysis 2012–2016 in Shanghai. Chinese Journal of Practical Surgery. 2018;36:94–6.
Jingang Liu. Current situation of surgical treatment of patients with obesity and type 2 diabetes. Chinese Journal of Practical Surgery 2014;34: 1021–1022,1025
Mastoraki A, Mastoraki S, Schizas D, et al. Facing the challenge of venous thromboembolism prevention in patients undergoing major abdominal surgical procedures for gastrointestinal cancer. World J Gastrointest Oncol. 2018;10(10):328–35.
Yang C, Zhu L. Coagulation and deep vein flow changes following laparoscopic total extraperitoneal inguinal hernia repair: a single-center, prospective cohort study. Surg Endosc. 2019; Feb 11. [Epub aehead of print]
Kopec AK, Abrahams SR, Thornton S, et al. Thrombin promotes diet-induced obesity through fibrin-driven inflammation. J Clin Invest. 2017;127(8):3152–66.
Forestieri P, Quarto G, De Caterina M, et al. Prophylaxis of thromboembolism in bariatric surgery with parnaparin. Obes Surg. 2007;17:1558–62.
Sharma A, Dahiya D, Kaman L, et al. Effect of various pneumoperitoneum pressures on femoral vein hemodynamics during laparoscopic cholecystectomy. Updates Surg. 2016;68(2):163–9.
Ntourakis D, Sergentanis TN, Geergiopoulos I, et al. Subclinical activation of coagulation and fibrinolysis in laparoscopic cholecystectomy: do risk factors exist? Int J Surg 2011; 9(5):374–377.
Tripodi A. Liver disease and hemostatic (dys) function. Semin Thromb Hemost. 2015;41:462–7.
Duxbury MB, Poller L. The oral anticoagulant saga: past, present, and future. Clin Appl Thromb Hemost. 2001;7:269–75.
Kim B, Jang S, Lee YJ, et al. Determination of the cut-off prothrombin time to estimate plasma rivaroxaban overdose status. Journal of Thrombosis and Thrombolysis. Published online:10 September 2019
Stroh C, Michel N, Luderer D, et al. Risk of thrombosis and thromboembolic prophylaxis in obesity surgery: data analysis from the German Bariatric Surgery registry. Obes Surg. 2016;26(11):2562–71.
Yu W, Yanting W, Zhongdong Z, et al. Effect of different position and CO2 pneumoperitoneum pressure of femoral venous hemodynamics. Chinese Journal of General Surgery. 2009;18:609–11.
Sobolewski AP, Deshmukh RM, Brunson BL, et al. Venous hemodynamic changes during laparoscopic cholecystectomy. J Laparoendosc Surg. 1995;5:363–9.
Schwenk W, Bohm B, Junghans T, et al. Intermittent sequential compression of the lower limbs prevents venous stasis in laparoscopy and conventional colorectal surgery. Dis Colon Rectum. 1997;40:1056–62.
Schwenk W, Bohm B, Witt C, et al. Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation. Arch Surg. 1999;134:6–13.
Yasui M, Ikeda M, Miyake M, et al. Comparison of bleeding risks related to venous thromboembolism prophylaxis in laparoscopic vs open colorectal cancer surgery: a multicenter study in Japanese patients. Am J Surg. 2017;213(1):43–9.
Casini A, Neerman-Arbez M, AriEns RA, et al. Dysfibrinogenemia: from molecular anomalies to clinical manifestations and management. J Thromb Haemost. 2015;13(6):909–19.
Amin B, Zhang C, Yan W, et al. Effects of pneumoperitoneum of laparoscopic cholecystectomy on the coagulation system of patients: a prospective observational study. Chin Med J. 2014;127(14):2599–604.
Linkins LA, Takach LS. Review of D-dimer testing: good, bad, and ugly. Int J Lab Hematol. 2017;39(Suppl 1):98–103.
Chapina JC, Hajjar KA. Fibrinolysis and the control of blood coagulation. Blood Rev. 2015;29(1):17–24.
Kleinegris MC, ten Cate H, ten Cate-Hoek AJ. D-dimer as a marker for cardiovascular and arterial thrombotic events in patients with peripheral arterial diseases. A systematic review. Thromb Haemost. 2013;110(2):233–43.
Trastulli S, Desiderio J, Guarino S, et al. Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials. Surg Obes Relat Dis. 2013;9:816–30.
Haifu W, Ming Z, Di Z, et al. Prevention, diagnosis and treatment of perioperative complications of bariatric and metabolic surgery. Chin J Gastrointest Surg. 2017;21:393–7.
Chinese Society for Metabolic & Bariatric Surgery (CSMBS). Surgery guideline for Chinese obesity and type 2 diabetes (2014). Chinese Journal of Practical Surgery. 2014;34(11):1005–10.
Chan MM, Hamza N, Ammori BJ. Duration of surgery independently influences risk of venous thromboembolism after laparoscopic bariatric surgery. Surg Obes Relat Dis. 2013;9(1):88–93.
Shida N, Kurasawa R, Maki Y, et al. Study of plasma coagulation induced by contact with calcium chloride solution. Soft Matter. 2016;12(47):9471–6.
Finks JF, English WJ, Carlin AM, et al. Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Ann Surg. 2012;255(6):1100–4.
Cao B, Wang J. Factors for hypercoagulable state formation after laparoscopic cholecystectomy: a prospective cohort study. Chinese Journal of General Surgery. 2017;26(8):1036–41.
Raftopoulos I, Martindale C, Cronin A, et al. The effect of extended post-discharge chemical thromboprophylaxis on venous thromboembolism rates after bariatric surgery: a prospective comparison trial. Surg Endosc. 2008;22(11):2384–91.
Altieri MS, Yang J, Hajagos J, et al. Evaluation of VTE prophylaxis and the impact of alternate regimens on post-operative bleeding and thrombotic complications following bariatric procedures. Surg Endosc. 2018;32:4805–12.
Venclauskas L, Maleckas A, Arcelus JI, et al. European guidelines on perioperative venous thromboembolism prophylaxis: surgery in the obese patient. Eu J Anaestesiol. 2018;35(2):147–53.
Bhattacharya S, Kumar SS, Swamy PDK, et al. Deep vein thrombosis prophylaxis: are we overdoing? An Asian survey on trends in bariatric surgery with a systematic review of literature. Journal of minimal access surgery. 2018;14(4):285–90.
Blanchet MC, Gignoux B, Matussiere Y, et al. Experience with an enhanced recovery after surgery (ERAS) program for bariatric surgery: comparison of MGB and LSG in 374 patients. Obes Surg. 2017;27(7):1896–900.
Conflict of Interest.
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in this study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Liu, C., Han, Z., Zhang, N. et al. Laparoscopic Sleeve Gastrectomy Affects Coagulation System of Obese Patients. OBES SURG 30, 3989–3996 (2020). https://doi.org/10.1007/s11695-020-04769-w
- Laparoscopic sleeve gastrectomy
- Coagulation system