.: ORİJİNAL ARAŞTIRMA
The Effect of Laparoscopic Sleeve Gastrectomy Applications on Coagulation in Morbidly Obese Patients: Clinical Research
Morbid Obez Hastalarda Laparoskopik Sleeve Gastrektomi Uygulamalarının Koagülasyona Etkisi: Klinik Araştırma
Turkiye Klinikleri J Med Sci. 2021;41(4):362-9
doi: 10.5336/medsci.2021-85155
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Obese patients have an increased predisposition to thrombosis and are at a high risk for thrombotic complications associated with bariatric surgeries. This study aimed to evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on coagulation parameters in morbidly obese patients. Material and Methods: This prospective study was performed with 40 American Society of Anesthesiologists II-III morbidly obese patients with a body mass index of ≥40 kg/m² who underwent LSG. Anaesthesia was maintained with sevoflurane after anaesthesia induction. Haemoglobin, haematocrit, platelet, D-dimer and fibrinogen levels as well as prothrombin time (PT), activated partial thromboplastin time (aPTT) and international normalised ratio (INR) were compared in blood samples taken before the operation and at 1, 24 and 48 hours after the operation. In addition, duration of operation, length of hospital stay and the presence of symptomatic thromboembolic complications within 7 days after the operation were examined. Results: A significant increase was observed in PT and INR in all postoperative periods (p<0.001). Although a significant decrease was observed at the 1st hour, a significant increase was observed at the 24th and 48th hours in aPTT postoperatively (p<0.01). Postoperative fibrinogen and D-dimer levels were significantly higher than the preoperative levels (p<0.01). No symptomatic thromboembolic event was observed in any patient in the early postoperative period. Conclusion: In morbidly obese patients undergoing LSG, coagulation parameters are affected in line with the increased risk of thrombosis. Close monitoring of these patients for postoperative thromboembolic complications is important.
Keywords: Bariatric surgery; obesity, morbid; thrombosis; fibrinogen; venous thromboembolism
Objective: Obese patients have an increased predisposition to thrombosis and are at a high risk for thrombotic complications associated with bariatric surgeries. This study aimed to evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on coagulation parameters in morbidly obese patients. Material and Methods: This prospective study was performed with 40 American Society of Anesthesiologists II-III morbidly obese patients with a body mass index of ≥40 kg/m² who underwent LSG. Anaesthesia was maintained with sevoflurane after anaesthesia induction. Haemoglobin, haematocrit, platelet, D-dimer and fibrinogen levels as well as prothrombin time (PT), activated partial thromboplastin time (aPTT) and international normalised ratio (INR) were compared in blood samples taken before the operation and at 1, 24 and 48 hours after the operation. In addition, duration of operation, length of hospital stay and the presence of symptomatic thromboembolic complications within 7 days after the operation were examined. Results: A significant increase was observed in PT and INR in all postoperative periods (p<0.001). Although a significant decrease was observed at the 1st hour, a significant increase was observed at the 24th and 48th hours in aPTT postoperatively (p<0.01). Postoperative fibrinogen and D-dimer levels were significantly higher than the preoperative levels (p<0.01). No symptomatic thromboembolic event was observed in any patient in the early postoperative period. Conclusion: In morbidly obese patients undergoing LSG, coagulation parameters are affected in line with the increased risk of thrombosis. Close monitoring of these patients for postoperative thromboembolic complications is important.
Keywords: Bariatric surgery; obesity, morbid; thrombosis; fibrinogen; venous thromboembolism
ÖZET
Amaç: Obez hastaların tromboza yatkınlığı yüksektir ve bariatrik cerrahilerle ilişkili trombotik komplikasyonlar açısından yüksek risk altındadır. Bu çalışma, morbid obez hastalarda laparoskopik sleeve gastrektominin (LSG) koagülasyon parametreleri üzerine etkisini değerlendirmeyi amaçladı. Gereç ve Yöntemler: Bu prospektif çalışma, beden kitle indeksi ≥40 kg/m² olan ve LSG geçiren Amerikan Anestezistler Derneği II-III 40 morbid obez hasta ile yapılmıştır. Hastalarda anestezi indüksiyonu sonrası sevofluran ile anestezi idamesi sağlandı. Operasyon öncesi, operasyon sonrası 1, 24 ve 48. saatlerde alınan kan örneklerinde hemoglobin, hematokrit, platelet, protrombin zamanı [prothrombin time (PT)], aktive parsiyel thromboplastin zamanı [activated partial thromboplastin time (aPTT)], 'international normalised ratio (INR),' D-dimer ve fibrinojen düzeyleri bakılarak karşılaştırıldı. Ayrıca hastalarda ameliyat süresi, hastane yatış süresi ve operasyon sonrası 7 gün içinde semptomatik tromboembolik komplikasyon varlığı incelendi. Bulgular: PT ve INR postoperatif tüm dönemlerde anlamlı artış gözlenmiştir (p<0,001). Postoperatif 1. saatde aPTT'de anlamlı düşme gözlenirken, 24 ve 48. saaatlerde anlamlı artış gözlenmiştir (p<0,01). Ameliyat sonrası fibrinojen ve D-dimer seviyeleri ameliyat öncesi seviyelere göre anlamlı derecede yüksekti (p<0,01). Postoperatif erken dönemde hiçbir hastada semptomatik tromboembolik hadise görülmemiştir. Sonuç: LSG geçiren morbid obez hastalarda, koagülasyon parametreleri artmış tromboz riskiyle uyumlu olarak etkilenmektedir. Operasyon sonrası tromboembolik komplikasyonlar açısından bu hastaların yakından takibi önemlidir.
Anahtar Kelimeler: Bariatrik cerrahi; obezite, morbid; tromboz; fibrinojen; venöz tromboembolizm
Amaç: Obez hastaların tromboza yatkınlığı yüksektir ve bariatrik cerrahilerle ilişkili trombotik komplikasyonlar açısından yüksek risk altındadır. Bu çalışma, morbid obez hastalarda laparoskopik sleeve gastrektominin (LSG) koagülasyon parametreleri üzerine etkisini değerlendirmeyi amaçladı. Gereç ve Yöntemler: Bu prospektif çalışma, beden kitle indeksi ≥40 kg/m² olan ve LSG geçiren Amerikan Anestezistler Derneği II-III 40 morbid obez hasta ile yapılmıştır. Hastalarda anestezi indüksiyonu sonrası sevofluran ile anestezi idamesi sağlandı. Operasyon öncesi, operasyon sonrası 1, 24 ve 48. saatlerde alınan kan örneklerinde hemoglobin, hematokrit, platelet, protrombin zamanı [prothrombin time (PT)], aktive parsiyel thromboplastin zamanı [activated partial thromboplastin time (aPTT)], 'international normalised ratio (INR),' D-dimer ve fibrinojen düzeyleri bakılarak karşılaştırıldı. Ayrıca hastalarda ameliyat süresi, hastane yatış süresi ve operasyon sonrası 7 gün içinde semptomatik tromboembolik komplikasyon varlığı incelendi. Bulgular: PT ve INR postoperatif tüm dönemlerde anlamlı artış gözlenmiştir (p<0,001). Postoperatif 1. saatde aPTT'de anlamlı düşme gözlenirken, 24 ve 48. saaatlerde anlamlı artış gözlenmiştir (p<0,01). Ameliyat sonrası fibrinojen ve D-dimer seviyeleri ameliyat öncesi seviyelere göre anlamlı derecede yüksekti (p<0,01). Postoperatif erken dönemde hiçbir hastada semptomatik tromboembolik hadise görülmemiştir. Sonuç: LSG geçiren morbid obez hastalarda, koagülasyon parametreleri artmış tromboz riskiyle uyumlu olarak etkilenmektedir. Operasyon sonrası tromboembolik komplikasyonlar açısından bu hastaların yakından takibi önemlidir.
Anahtar Kelimeler: Bariatrik cerrahi; obezite, morbid; tromboz; fibrinojen; venöz tromboembolizm
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