Ann. Coll. Surg. H.K. (2003) 7, 52–54 View point Blackwell Science, LtdOxford, UKASHAnnals of the College of Surgeons of Hong Kong1028-40012003 Blackwell Publishing Asia Pty LtdMay 2003725254ViewpointLaparoscopic abdominal surgeryAWN Meshikhes Correspondence address: PO Box 18418, Qatif 31911, Saudi Arabia. Email: meshikhes@doctor.com Received 1 November 2002; accepted 23 January 2003. View point Thromboprophylaxis in laparoscopic abdominal surgery Abdul-Wahed N. Meshikhes Department of Surgery, Dammam Central Hospital, Dammam, Saudi Arabia. Background: Since the introduction of laparoscopic cholecystectomy, there has been a great concern regarding the increased risk of thromboembolism following laparoscopic surgery. However, in the absence of clear guidelines, the use of thromboprophylaxis in laparoscopic abdominal surgery is controversial. Methods: The evidence for and against routine and selective thromboprophylaxis in patients undergoing laparoscopic abdominal procedures was reviewed based mainly on published British and Danish surveys, together with the author’s own survey. An attempt was made to come up with a generally-accepted protocol for thromboprophylaxis in laparoscopic surgery. Results: Less thromboembolic events were encountered by laparoscopic surgeons who adopt routine thromboprophylaxis. More thromboembolic events following laparoscopic abdominal surgery were encoun- tered by surgeons adopting selective thromboprophylaxis policy. Conclusion: Routine thromboprophylaxis seems to be more effective in protection against thromboembo- lism. However, this warrants further confirmation by prospective randomized trials. Key words: deep venous thrombosis, laparoscopic abdominal surgery, laparoscopic cholecystectomy, thromboprophylaxis. Introduction Since the introduction of laparoscopic cholecystec- tomy (LC), there has been a great concern regarding the possible increased incidence of thromboembolism during laparoscopic surgery. The elevated intra- abdominal pressure after the induction of pneumo- peritoneum results in a significant disturbance of venous blood flow in the lower extremities. 1 Therefore, the intraoperative use of intermittent pneumatic com- pression device is advocated to correct the negative changes in venous stasis during laparoscopic sur- gery. This measure may effectively reduce the incidence of postoperative thromboembolic complica- tions. 1 However, the use of such devices alone may not provide adequate protection against deep venous thrombosis (DVT). 2 In contrast, recent studies into the effects of pneumo- peritoneum on the venous outflow resistance of the lower limbs revealed no significant change during lap- aroscopic procedures and therefore there is no obstruction to the lower limbs venous outflow by the presumed pressure on the inferior vena cava. 3 If this is the case, then no special anti-DVT measures should be undertaken and the indications for DVT-prophylaxis should therefore be similar to those implemented in the prelaparsocopic era as suggested by the Society of American Gastrointestinal Endoscopic Surgeons in April 1998. However, some authors feel strongly that pneumoperitoneum does predispose to DVT, 4 espe- cially during prolonged laparoscopic abdominal pro-