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Deep venous thrombosis after laparoscopic cholecystectomy and prevention with nadroparin
J T H Schaepkens Van Riempst1, R H G G Van Hee, J J J Weyler
1Academic Surgical Center Stuivenberg, General Centrum Hospital Antwerp, University of Antwerp - UIA, Lange Beeldekensstraat 267, B-2060 Antwerp-Belgium.
Background:
Postoperative thromboembolic disease has been suggested to occur with higher frequency during laparoscopic cholecystectomy than during other laparoscopic procedures or conventional cholecystectomy. The aim of this prospective study was to evaluate the occurrence of deep vein thrombosis (DVT) in laparoscopic cholecystectomy patients, whether they were treated with low-molecular-weight heparins or not.
Methods:
All 238 laparoscopic cholecystectomy patients included in the study underwent pre- and postoperative venous duplex scanning of both legs. Subcutaneous Nadroparin was administred to 105 patients. The remaining 133 patients did not receive pharmacologic prophylaxis. The different risk factors for thromboembolic disease were distributed evenly between the two groups, except for the duration of general anesthesia.
Results:
No patient had postoperative clinical manifestations of DVT or pulmonary embolism. In five patients, DVT was detected at duplex scan approximately 10 days after surgery. Four DVTs were found among the 133 patients who did not receive Nadroparin (1.68%). In the group with pharmacologic prevention, one patient manifested a DVT (0.42%), giving a total DVT incidence of 2.10% after laparoscopic cholecystectomy. The difference between the two groups was not significant (p = 0.27), but the results seem to indicate a tendency toward a lower incidence in the Nadroparine group.
Conclusions:
In the light of the study results, it seems advisable to use thromboembolic prophylaxis during laparoscopic cholecystectomy.