Six cases of portomesenteric vein thrombosis after 3511 patients of bariatric surgery without prophylactic anticoagulation

Abstract Background: Portomesenteric vein thrombosis (PMVT) is a rare but potentially life-threatening complication following bariatric surgery (BS). Due to the limited number of reported cases, the clinical presentation, management, and outcomes of PMVT are not well understood. Objective: This study aims to describe the incidence, clinical presentation, treatment, and outcomes of PMVT in patients who underwent BS at a single bariatric surgery center. Methods: We conducted a retrospective review of a database of all patients who underwent BS and developed PMVT from July 2018 to April 2024 at one center. Results: Out of 3511 patients who underwent BS, 2981 had laparoscopic sleeve gastrectomy (LSG) and 530 had laparoscopic Roux-en-Y gastric bypass (LRYGB). None of the patients received prophylactic anticoagulation post-surgery. Six patients (0.17%) who underwent LSG were diagnosed with PMVT. These patients had a mean age of 33.3 years and a mean preoperative body mass index (BMI) of 42.13 kg/m². The average time to diagnosis post-surgery was 11.5 days (range 10–36 days). All patients presented with epigastric pain. Treatment was exclusively medical, with no reoperations. Five patients were treated with enoxaparin, and all were treated with rivaroxaban for an average of four months (range 45–210 days). There were no fatalities. Conclusion: Portal mesenteric vein thrombosis (PMVT) is a rare but serious complication following bariatric surgery, often presenting with nonspecific symptoms. High suspicion is essential for early diagnosis. At our center, the incidence of PMVT is relatively lower compared to previous studies that did not employ routine prophylactic anticoagulation. Further research is needed to determine whether routine prophylactic anticoagulation is necessary.