Systemic coagulation and fibrinolysis after laparoscopic and open gastric bypass.
OBJECTIVE
Laparoscopic gastric bypass (GBP) induces a postoperative hypercoagulable state that is similar or reduced compared with open GBP.


METHODS
University hospital.


METHODS
Between May 1999 and June 2000, 70 patients were randomly assigned to laparoscopic (n = 36) or open (n = 34) GBP. Deep venous thrombosis (DVT) prophylaxis consisted of antiembolism stockings and sequential pneumatic compression devices.


METHODS
Plasminogen, thrombin-antithrombin complex (TAT), prothrombin 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 hours postoperatively. A venous duplex examination of both lower extremities was performed preoperatively and between the third and fifth day postoperatively.


RESULTS
The 2 groups were similar in age, weight, and body mass index. Plasminogen levels decreased, and TAT, F1.2, and fibrinogen levels increased after laparoscopic and open GBP. There was no significant difference in these levels between groups. D-dimer levels increased in both groups, but the levels were significantly higher after open GBP than after laparoscopic GBP (P<.01). Antithrombin III and protein C levels decreased in both groups. The 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 venous duplex examination revealed DVT in 1 (2.9%) of 34 patients after open GBP 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 that of open GBP. Our findings suggest that DVT prophylaxis should be used during laparoscopic GBP as in open GBP.
Nguyen
N T
NT
Department of Surgery, University of California, Davis, Medical Center, 2221 Stockton Blvd, 3rd Floor, Sacramento, CA 95817-1418, USA. ninh.nguyen@ucdmc.ucdavis.edu
Owings
J T
JT
Gosselin
R
R
Pevec
W C
WC
Lee
S J
SJ
Goldman
C
C
Wolfe
B M
BM
D000328:Adult; D000990:Antithrombin III / Q000378:metabolism; D001458:Bandages; D001779:Blood Coagulation Factors / Q000378:metabolism*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods*; D005676:Gravity Suits; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000378:metabolism; D010958:Plasminogen / Q000378:metabolism; D011486:Protein C / Q000378:metabolism; D011516:Prothrombin / Q000378:metabolism; D020246:Venous Thrombosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*
D001779:Blood Coagulation Factors; D005338:Fibrin Fibrinogen Degradation Products; D011486:Protein C; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; D000990:Antithrombin III; D011516:Prothrombin; D005340:Fibrinogen; D010958:Plasminogen; D010447:Peptide Hydrolases