Postoperative portomesenteric venous thrombosis: lessons learned from 1,069 consecutive laparoscopic colorectal resections.
BACKGROUND
Portomesenteric venous thrombosis (PVT) is a known complication after open and laparoscopic colorectal (LCR) surgery. Risk factors and the prognosis of PVT have been poorly described.


METHODS
This study is a retrospective analysis of a prospectively collected database. Patients with new-onset postoperative abdominal pain were evaluated with a computed tomography scan of the abdomen. Patients found to have PVT were analyzed. A multivariate analysis was performed to identify predictors of PVT.


RESULTS
A total of 1,069 patients undergoing LCR surgery for inflammatory bowel disease (IBD) or nonmetastatic cancer between June 2002 and June 2012 were included. Altogether, 37 (3.5 %) patients experienced symptomatic postoperative PVT. On univariate analysis, IBD (p < 0.001), ulcerative colitis (p = 0.016), preoperative therapy with steroids (p = 0.008), operative time ≥220 min (p = 0.004), total proctocolectomy (TPC) (p < 0.001), ileoanal pouch anastomosis (p = 0.006), and postoperative intraabdominal septic complications (p < 0.001) were found to be significant risk factors. By multivariate analysis, TPC (p = 0.026) and postoperative intraabdominal septic complications (p < 0.001) were independent predictors of PVT. In the PVT group, postoperative length of stay was longer (14.8 vs. 7.4 days, p < 0.001). Of the patients evaluated with a hematologic workup, 72.7 % were found to have a hypercoagulable condition. All patients were managed with oral anticoagulation for at least 6 months. No death or complications related to PVT occurred.


CONCLUSIONS
PVT is a potentially serious complication that is more likely to occur after TPC and in the presence of postoperative intraabdominal septic complications, particularly in patients with a coagulation disorder. Prompt diagnosis and treatment with oral anticoagulation are recommended to avoid long-term sequelae.
Department of Surgery, University of Chicago Medical Center, MC 5095, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA, meallaix@gmail.com.
Marco E
ME
Allaix
Mukta K
MK
Krane
Marco
M
Zoccali
Konstantin
K
Umanskiy
Roger
R
Hurst
Alessandro
A
Fichera
D000328:Adult; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000453:epidemiology / Q000209:etiology*; D008642:Mesenteric Veins; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016737:Proctocolectomy, Restorative; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology*