Systemic coagulation and fibrinolysis after laparoscopic and open gastric bypass

Hypothesis: Laparoscopic gastric bypass (GBP) induces a postoperative hyper coagulable state that is similar or reduced compared with open GBP. Setting: University hospital. Patients: Between May 1999 and June 2000, 70 patients were randomly assigne d to laparoscopic (n=36) or open (n=34) GBP. Deep venous thrombosis (DVT) p rophylaxis consisted of antiembolism stockings and sequential pneumatic com pression devices. Main Outcome Measures: Plasminogen, thrombin-antithrombin complex (TAT), pr othrombin fragment 1.2 (F1.2), fibrinogen, D-dimer, antithrombin III (AT), and protein C levels were measured at baseline and at 1, 24, 48, and 72 hou rs postoperatively. A venous duplex examination of both lower extremities w as performed preoperatively and between the third and fifth day postoperati vely. Results: The 2 groups were similar in age, weight, and body mass index. Pla sminogen levels decreased, and TAT, F1.2, and fibrinogen levels increased a fter laparoscopic and open GBP. There was no significant difference in thes e levels between groups. D-dimer levels increased in both groups, but the l evels were significantly higher after open GBP than after laparoscopic GBP (P<.01). Antithrombin III and protein C levels decreased in both groups. Th e reduction of AT (at 1 hour) and protein C (at 72 hours) was significantly less after laparoscopic GBP than after open GBP (P<.05). Postoperative ven ous duplex examination revealed DVT in 1 (2.9%) of 34 patients after open G BP but in none of 36 patients after laparoscopic GBP. One patient developed pulmonary embolism after open GBP. Conclusions: Laparoscopic GBP induces a hypercoagulable state similar to th at of open GBP. Our findings suggest that DVT prophylaxis should be used du ring laparoscopic GBP as in open GBP.