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The Safety of Laparoscopic Sleeve Gastrectomy in Patients Receiving Chronic Anticoagulation Therapy: A Case-Matched
Olivier Gerin1, Lionel Rebibo, Abdennaceur Dhahri
1Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France.
Insights
Laparoscopic sleeve gastrectomy (LSG) is safe for patients on chronic anticoagulation therapy (CAT). This study found no increased risk of bleeding or other complications in patients undergoing LSG while on CAT.
Area of Science:
- Bariatric Surgery
- Cardiology
- Anticoagulation Therapy
Background:
- Obesity is linked to atrial fibrillation, often requiring chronic anticoagulation therapy (CAT).
- CAT increases the risk of postoperative bleeding after elective surgery.
- The safety of laparoscopic sleeve gastrectomy (LSG) in patients on CAT is not well-established.
Purpose of the Study:
- To evaluate short- and long-term complications of LSG in patients receiving CAT.
- To compare complication rates between patients on CAT and those not on CAT undergoing LSG.
Main Methods:
- Retrospective analysis of a prospective database of patients undergoing LSG.
- Matching CAT patients (LSG-CAT group) 1:2 with control patients (LSG-control group) based on preoperative data.
- Assessing CAT-related complications, major postoperative complications, revisional surgery rates, and changes in oral anticoagulant dosage.
Main Results:
- The LSG-CAT group (15 patients) and LSG-control group (30 patients) had similar operating times.
- Major complication rates were 13.3% in LSG-CAT and 3.3% in LSG-control (p=0.20).
- Postoperative bleeding occurred in one patient in each group (6.7% vs 3.3%, p=0.6); no mortalities were reported.
Conclusions:
- LSG in patients on CAT is not associated with CAT-specific complications.
- LSG provides effective weight loss without requiring changes in oral anticoagulant dosage.
- LSG can be considered a safe option for obese patients with atrial fibrillation requiring anticoagulation.
Background:
Obesity is linked to cardiac disorders with a relative risk of atrial fibrillation of 1.5 (requiring the use of chronic anticoagulation therapy, CAT). However, CAT is a known risk factor for postoperative bleeding after elective surgery. The primary objective of the present study was to evaluate the short- and long-term complications of laparoscopic sleeve gastrectomy (LSG) in patients receiving CAT.
Methods:
This is a retrospective analysis of a prospective database of CAT patients undergoing LSG between March 2004 and December 2012. This LSG-CAT group was matched 1:2 on preoperative data with patients not receiving CAT (LSG-control group). Primary efficacy criterion was the frequency of CAT-related complications. Secondary efficacy criteria were the major postoperative complications, frequency of revisional surgery, long-term CAT-related complications, and a change in the dose level of oral anticoagulants.
Results:
The LSG-CAT group consisted of 15 patients with a median age of 54 years (32-65). The LSG-control group consisted of 30 patients. Median operating time was 75 min in both groups (p = 0.33). Major complication rates in the LSG-CAT and LSG-control groups were 13.3 and 3.3 %, respectively (p = 0.20), with one case of postoperative bleeding in each group (6.7 and 3.3 %, p = 0.6); incidence of revisional surgery was 13.3 and 3.3 % (p = 0.2). There were no postoperative mortalities. After a median follow-up of 14 months (9-43), no changes in the dose level of oral anticoagulants were reported.
Conclusions:
LSG in patients receiving CAT is not associated with CAT-specific complications. This surgical procedure enables good weight loss and does not require change in the dose level of oral anticoagulants.
