Incidence of clinically evident deep venous thrombosis after laparoscopic Roux-en-Y gastric bypass Q. H. Gonzalez, D. S. Tishler, J. J. Plata-Munoz, A. Bondora, S. M. Vickers, T. Leath, R. H. Clements Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, KB 405, 1503 3rd Avenue South, Birmingham, AL 35294-0016, USA Received: 13 January 2004/Accepted: 29 January 2004/Online publication: 27 May 2004 Abstract Background: Advanced age, major orthopedic surgery, neoplastic disease, prolonged operations, varicose veins, immobilization, estrogen-containing medications, and obesity are known risk factors for the development of postoperative thromboembolic complications. Periop- erative heparin is useful for reducing the incidence of deep venous thrombosis (DVT), but it is associated with a discrete bleeding rate. The purpose of this study was to determine the incidence of clinically evident DVT in morbidly obese patients after laparoscopic Roux-en-Y gastric bypass when a pneumatic compression hose is used as the only prophylaxis against DVT instead of anticoagulants. Methods: From April 2000 to April 2003, 380 patients underwent laparoscopic Roux-en-Y gastric bypass for morbid obesity by one surgeon (R.H.C.). Prospectively, each patient was clinically evaluated for the presence of DVT during the postoperative period. Calf-length pneumatic compression stockings were placed before the procedure began, and remained in place until the patient was ambulatory. Ambulation was encouraged on the evening of the operation. No pharmacologic anticoag- ulant was used as a prophylaxis against DVT. Results: Of the 380 patients, 346 were women and 34 were men with a mean age of 39.3 ± 9.4 years (range, 14–65 years). The mean weight of these patients was 299.5 ± 53.6 lb (range, 188–483 lb), and their mean body mass index was 48.5 ± 6.6 (range, 36–70). The mean operative time was 103. 3 ± 24.3 min (range, 62– 227 min), and mean American Society of Anesthesiol- ogy (ASA) score was 2.6. Nine patients had clinical evidence of severe, chronic venous disease preopera- tively. One patient (0.26%) experienced a clinically evi- dent DVT limited to the popliteal vein on duplex ultrasonography. The clot resolved completely, as evi- denced by follow-up duplex ultrasonography after 2 weeks of subcutaneously injected fractionated heparin. No clinically evident pulmonary thromboembolism oc- curred in this study group. Conclusions: The incidence of clinically evident DVT after laparoscopic Roux-en-Y gastric bypass is low when the procedure is accomplished with a relatively short operative time, with the initiation of calf-length pneumatic compression hose before the induction of anesthesia, and with routine early ambulation. No form of heparin anticoagulation is mandatory when these conditions can be met. Key words: Laparoscopic Roux-en-Y gastric bypass — Deep venous thrombosis — Pulmonary embolism — Pneumatic compression — Heparin — Morbid obesity — Ambulation Multiple factors including advanced age, major ortho- pedic surgery, malignancies, prolonged operations, varicose veins, immobilization, estrogen medication, and obesity are well recognized risk factors for the de- velopment of postoperative deep venous thrombosis (DVT) [1, 6, 8, 9]. The pneumoperitoneum used for laparoscopic procedures has been proposed as a poten- tial risk factor for the development of DVT because of its relation to venous stasis produced in the lower ex- tremities [13]. Obesity has been implicated as a risk factor in the development of many postoperative com- plications, and one of the more lethal of these compli- cations is DVT with pulmonary thromboembolism (PTE) [1, 11–13]. A number of regimens have been recommended for the prevention of perioperative DVT. Preoperative Presented as a poster at the annual Society of American Gastrointes- tinal and Endoscopic Surgeons (SAGES) meeting, Los Angeles, CA, USA, March 10–15, 2003 Correspondence to: R. H. Clements Surg Endosc (2004) 18: 1082–1084 DOI: 10.1007/s00464-003-8202-1 Ó Springer-Verlag New York, LLC 2004