title: Venous thromboembolism after laparoscopic biliopancreatic diversion with duodenal switch: analysis of 362 patients.
abstract: BACKGROUND
  Venous thromboembolism (VTE), which manifests as deep venous thrombosis (DVT) or pulmonary embolism (PE), is relatively uncommon after weight loss procedures but has the strong potential to affect patient morbidity and mortality. This type of complication has been studied extensively in more common weight loss procedures, such as Roux-en-Y gastric bypass (RYGB). VTE has not been studied after biliopancreatic diversion with duodenal switch (BPD-DS), a bariatric procedure performed mainly for super morbidly obese patients, who are inherently associated with a higher incidence of co-morbidity. The objective of this study was to review VTE prevalence and identify risk factors associated with the postoperative occurrence of VTE in a collected data set of patients after laparoscopic BPD-DS.
  
  
  METHODS
  The database of all patients who underwent laparoscopic BPD-DS between 2006 and 2012 was reviewed. Preoperative clinical information, which included history of VTE, inferior vena cava (IVC) filter placement, operative variables, and postoperative course, were reviewed. All VTE related events that occurred within 90 days postoperatively were collected and analyzed.
  
  
  RESULTS
  Of 362 patients who underwent laparoscopic BPD-DS during the study period, 12 (3.3%) experienced a VTE complication. Eight (2.2%) patients presented with DVT; 4 (1.1%) patients presented with PE. VTE complications were more common in females than males (83.3% versus 16.6%, respectively). Age, body mass index (BMI), and time interval between preoperative and postoperative doses of heparin for DVT prophylaxis did not influence the occurrence of VTE complications. However, operative time (P = .02) and length of hospital stay (P = .0005) were identified as risk factors associated with postoperative VTE complications. No related mortality occurred in this study.
  
  
  CONCLUSIONS
  The prevalence of VTE after BPD-DS is relatively low and comparable to other weight loss procedures. Overall risk of postoperative VTE after laparoscopic BPD-DS appears to be associated with the length of operation and hospital stay.
authors.affiliation: Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania. Electronic address: masrezvani@gmail.com.
authors.forename: Masoud
authors.initials: M
authors.lastname: Rezvani
authors.affiliation: Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania.
authors.forename: Iswanto
authors.initials: I
authors.lastname: Sucandy
authors.affiliation: Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania.
authors.forename: Riva
authors.initials: R
authors.lastname: Das
authors.affiliation: Department of Medicine, Abington Memorial Hospital, Abington, Pennsylvania.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Naglak
authors.affiliation: Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania.
authors.forename: Fernando B
authors.initials: FB
authors.lastname: Bonanni
authors.affiliation: Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania.
authors.forename: Gintaras
authors.initials: G
authors.lastname: Antanavicius
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D015904:Biliopancreatic Diversion / Q000009:adverse effects* / Q000379:methods; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
keywords: Biliopancreatic diversion with duodenal switch; Deep vein thrombosis; Pulmonary embolism