A Rare Cause of Abdominal Pain After Laparoscopic Sleeve Gastrectomy: Portomesenteric and Splenic Vein Thrombosis

Abstract

Aim: This study aimed to determine the incidence, predisposing factors, clinical presentation, and treatment options for portomesenteric and splenic vein thrombosis (PMSVT) in patients undergoing laparoscopic sleeve gastrectomy (LSG). Materials and Methods: A retrospective study was conducted of 507 patients who had LSG between March 2015 and June 2020. All patients received an extended (10 day) deep vein thrombosis prophylaxis protocol. Results: Of 436 patients who underwent LSG, four developed (0.9%) PMSVT. There was no significant difference in age or body mass index between patients with and without PMSVT (p = 0.547 and p = 0.535, respectively). There was a positive correlation between preoperative platelet (Plt-pre) values and PMSVT (p = 0.028, r = 0.157). The cutoff value for Plt-pre was 378 x 10(3) in receiver operating characteristic curve analysis (area under the ROC curve = 0.937, Youden index = 0.928, p < 0.001) with 100% sensitivity and 92.8% specificity rates. Plt-pre was found to be an independent risk factor for the development of PMSVT (odds ratio = 1.031, p = 0.046). There was no statistically significant difference in preoperative mean platelet volume (MPV-pre) between patients with and without PMSVT and MPV-pre was not found to be a risk factor for the development of PMSVT (p > 0.05). Conclusion: PMSVT is an infrequent but serious complication associated with bariatric surgery, especially LSG. The only independent risk factor was Plt-pre count.