Systemic coagulation and fibrinolysis after laparoscopic and open gastric bypass

Citation
Nt. Nguyen et al., Systemic coagulation and fibrinolysis after laparoscopic and open gastric bypass, ARCH SURG, 136(8), 2001, pp. 909-915
Citations number
23
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
ARCHIVES OF SURGERY
ISSN journal
00040010 → ACNP
Volume
136
Issue
8
Year of publication
2001
Pages
909 - 915
Database
ISI
SICI code
0004-0010(200108)136:8<909:SCAFAL>2.0.ZU;2-Z
Abstract
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.