• Manish Parikh, Andrew Adelsheimer, Eduardo Somoza, John K Saunders, Ude Welcome Akuezunkpa A Department of Surgery NYU Langone Medical Center/Bellevue Hospital Center, New York, New York., Patricia Chui, Christine Ren-Fielding, Marina Kurian, George Fielding, Ajay Chopra, Richie Goriparthi, Mitchell Roslin, Che Afaneh, Alfons Pomp, Edward Chin, and H Leon Pachter.
• Department of Surgery NYU Langone Medical Center/Bellevue Hospital Center, New York, New York. Electronic address: manish.parikh@nyumc.org.
• Surg Obes Relat Dis. 2017 Nov 1; 13 (11): 1835-1839.

BackgroundPortomesenteric vein thrombosis (PMVT) has been increasingly reported after laparoscopic sleeve gastrectomy (LSG). Factor VIII (FVIII) is a plasma sialoglycoprotein that plays an essential role in hemostasis. There is increasing evidence that FVIII elevation constitutes a clinically important risk factor for venous thrombosis.ObjectivesTo report the prevalence of FVIII elevation as well as other clinical characteristics in a multicenter series of patients who developed PMVT after LSG.SettingUniversity hospitals.MethodsA retrospective review was conducted of all patients that developed PMVT after laparoscopic bariatric surgery from 2006 to 2016 at 6 high-volume bariatric surgery centers.ResultsForty patients who developed PMVT postoperatively, all after LSG, were identified. During this timeframe, 25,569 laparoscopic bariatric surgery cases were performed, including 9749 LSG (PMVT incidence after LSG = .4%). Mean age and body mass index were 40 years (18-65) and 43.4 kg/m2 (35-59.7), respectively. Abdominal pain was the most common (98%) presenting symptom. Of patients, 92% had a hematologic abnormality identified, and of these, FVIII elevation was the most common (76%). The vast majority (90%) was successfully managed with therapeutic anticoagulation alone. A smaller number of patients required small bowel resection (n = 2) and surgical thrombectomy (n = 1). There were no mortalities.ConclusionsA high index of clinical suspicion and prompt diagnosis/treatment of PMVT usually leads to favorable outcomes. FVIII elevation was the most common (76%) hematologic abnormality identified in this patient cohort. Further studies are needed to determine the prevalence of FVIII elevation in patients seeking bariatric surgery.Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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