Thromboembolism in laparoscopic surgery: Risk factors and preventive measures

The aim of this study was to assess the risk of clinical thromboembolism in laparoscopic digestive surgery. From June 1992 to June 1997, 2,384 consecu tive patients were studied. All received perioperative prophylaxis with low -molecular-weight heparin (LMWH), which was continued until full mobility w as regained. Eight cases (0.33%) of deep venous thrombosis were noted, but there were no cases of pulmonary embolus. In six cases (five cholecystectom ies with reverse Trendelenburg position and one inguinal hernia repair), re lease of the pneumoperitoneum took longer than 2 hours, and in two cases (o ne rectopexy and one sigmoid colectomy for diverticulitis), longer than 3 h ours. In six of the eight cases, the diagnosis of DVT was made after LMWH h ad been ceased and the patient had been discharged. All cases were diagnose d before the 10th postoperative day. Pneumoperitoneum is felt to predispose to deep venous thrombosis. Long operations and reverse Trendelenburg posit ion are further potentiating factors. Thromboprophylaxis for laparoscopy sh ould be the same as for conventional surgery, i.e., tailored to individual risk and continued for a minimum of 7 to 10 days. We also recommend using g raduated compression stockings, maintaining a relatively low insufflation p ressure, keeping use of the reverse Trendelenberg position to a minimum, an d intermittently releasing the pneumoperitoneum in longer procedures.