Deep venous thrombosis prophylaxis is not indicated for laparoscopic cholecystectomy

Recent publications have discussed the risk of deep venous thrombosis during laparoscopic cholecystectomy and the need for routine deep venous thrombosis (DVT) prophylaxis. The purpose of this study was to determine the incidence of clinically detectable DVT in patients undergoing laparoscopic cholecystectomy without a standard DVT prophylaxis regimen.

We performed completed laparoscopic cholecystectomy in 587 patients over a 4-year period. Eighteen of these patients received some form of perioperative DVT prophylaxis, and 569 patients did not. Routine screening with a duplex Doppler was not used. Patients were followed postoperatively for 4 weeks after discharge from the hospital.

In an average of 4 weeks follow-up, 31 complications and 4 deaths were reported. These complications included wound infection (16), postoperative bleeding (3), persistent pain (3), pneumonia (3), retained CBD stones (2), asthma (1), papillary stenosis (1), ileus (1), and intraoperative bowel injury (1). None of the 587 patients in this study had symptoms of DVT or pulmonary embolism.

Despite the fact that DVT in this patient population is rare, many reports suggest the use of routine DVT prophylaxis with sequential compression devices (SCDs) or low-molecular-weight heparin (LMWH). Because no clinically detectable evidence was found of DVT in our study group despite the lack of any perioperative DVT prophylaxis, we question whether routine DVT prophylaxis is indicated or cost effective for routine laparoscopic cholecystectomy. A large prospective trial addressing this question is needed.