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Low frequency of phlebographic deep vein thrombosis after laparoscopic cholecystectomy--a pilot study
Fredrik Lindberg1, Martin Björck, Ib Rasmussen
1Department of Surgery, Umeå University Hospital, Umeå, Sweden. 0910.51345@telia.com
Insights
The study found a low rate of deep vein thrombosis (DVT) after laparoscopic cholecystectomy, with only 2.0% of patients developing DVT. D-dimer levels suggest prolonged effects on coagulation post-surgery.
Area of Science:
- Vascular Surgery
- Thromboembolism Research
- Laparoscopic Procedures
Background:
- Deep vein thrombosis (DVT) is a potential complication following surgical procedures.
- Laparoscopic cholecystectomy (LC) is a common surgical intervention with varying risks of thromboembolic events.
- Understanding DVT incidence post-LC is crucial for optimizing patient care and prophylaxis strategies.
Purpose of the Study:
- To determine the incidence of deep vein thrombosis (DVT) in patients undergoing laparoscopic cholecystectomy (LC).
- To evaluate the effectiveness of thromboembolism prophylaxis (low molecular weight heparin or dextran) in preventing DVT after LC.
- To assess the changes in D-dimer levels as an indicator of coagulation and fibrinolysis post-LC.
Main Methods:
- Bilateral phlebography was performed on 50 patients 7-11 days after LC.
- Patients received either low molecular weight heparin (LMWH) or dextran for thromboembolism prophylaxis.
- D-dimer levels were measured preoperatively, on postoperative day 1, and on the day of phlebography.
Main Results:
- The incidence of phlebographically confirmed DVT was 2.0% (1 of 49 patients).
- No asymptomatic DVTs were detected in the remaining patients with adequate phlebogram quality.
- D-dimer levels showed significant increases on day 1 and at the time of phlebography, indicating sustained effects on coagulation/fibrinolysis.
Conclusions:
- The frequency of deep vein thrombosis (DVT) after laparoscopic cholecystectomy appears low, even with prophylaxis of potentially questionable efficacy.
- Elevated D-dimer levels suggest that the impact of LC on coagulation and fibrinolysis extends beyond one week post-surgery.
- Further research may be warranted to refine DVT prophylaxis protocols and interpret D-dimer dynamics after LC.
Abstract:
To investigate the rate of deep vein thrombosis (DVT) after laparoscopic surgery, 50 patients underwent bilateral phlebography 7-11 days after laparoscopic cholecystectomy (LC). All received thromboembolism prophylaxis, either low molecular weight heparin (LMWH) or dextran. Three patients were converted to open cholecystectomy. D-dimer was investigated preoperatively, on day 1 and on the day of phlebography. One asymptomatic DVT was found. One phlebogram was incomplete. Seven phlebograms were not optimal but of sufficient quality to rule out DVT. The frequency of DVT was thus 1 of 49 or 2.0% (95% confidence interval, 0-6.0%). No anticoagulants were prescribed after discharge. No patient developed late thromboembolic complications. D-dimer values increased significantly at day 1 and were further increased at the time of phlebography. The frequency of phlebographical DVTs thus seems to be low despite prophylaxis of questionable efficacy. The D-dimer values, however, suggest that the effects of LC on coagulation/fibrinolysis have a duration of longer than 1 week.