title: The incidence of pulmonary embolism in open versus laparoscopic gastric bypass.
abstract: Obesity independently increases the risk of pulmonary embolism (PE). We compare a superobese population (body mass index [BMI] > 55 kg/m(2)) undergoing open gastric bypasses (OGBs) with a similarly matched group of laparoscopic gastric bypasses (LGB) to see if the incidence of PE differs. We included all patients undergoing OGB (n = 193, average BMI = 51 kg/m(2)) at our institution by a single surgeon between July 1999 and April 2001. Thirty-one patients were superobese (BMI > 55 kg/m(2)). LGB was started at our institution in April 2001. Since that time 213 patients (average BMI = 52 kg/m(2)) have undergone the procedure. One hundred and nine patients were superobese. Pre- and postoperative prophylaxis included sequential compression stockings and subcutaneous heparin. Postoperatively, patients who developed signs of hypoxia, tachypnea, or tachycardia underwent a chest X-ray and spiral computed tomography. In addition, all patients who expired in the 30-day postoperative period underwent postmortem examination. Data were analyzed using the chi-squared test. In the OGB group, four patients (2.1%) developed PE. All occurred in superobese patients with a BMI > 55 kg/m(2). Three were fatal PEs and one was nonfatal. None of these patients had a prior history of deep vein thrombosis, PE, venous stasis disease, or pulmonary hypertension. In the LGB group, one patient (0.9%) had a nonfatal PE. This patient had a history of deep vein thrombosis. The incidence of PE was statistically higher in the superobese OGB group (P < 0.01). Despite the theoretical hindrance to venous return and vena caval compression observed with pneumoperitoneum, fewer PEs occurred in the laparoscopic group. Our data, however, suggest that patients with a BMI > 55 kg/m(2) might be at an increased risk for PE independent of operative approach.
authors.affiliation: Division of Vascular Surgery, Montefiore Medical Center, Bronx, NY 10467, USA. ngargiul@montefiore.org
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Gargiulo
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Veith
authors.forename: Evan C
authors.initials: EC
authors.lastname: Lipsitz
authors.forename: William D
authors.initials: WD
authors.lastname: Suggs
authors.forename: Takao
authors.initials: T
authors.lastname: Ohki
authors.forename: Elliot
authors.initials: E
authors.lastname: Goodman
authors.forename: Pratt
authors.initials: P
authors.lastname: Vemulapalli
authors.forename: Karen
authors.initials: K
authors.lastname: Gibbs
authors.forename: Julio
authors.initials: J
authors.lastname: Teixeira
mesh_terms: D000713:Anastomosis, Roux-en-Y; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D015992:Body Mass Index; D016022:Case-Control Studies; D005268:Femoral Vein / Q000473:pathology; D015390:Gastric Bypass / Q000379:methods*; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007279:Injections, Subcutaneous; D010535:Laparoscopy / Q000379:methods*; D009519:New York City / Q000453:epidemiology; D009767:Obesity, Morbid / Q000601:surgery; D011655:Pulmonary Embolism / Q000453:epidemiology*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D053828:Stockings, Compression; D015996:Survival Rate; D036542:Tomography, Spiral Computed; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000453:epidemiology