Presenting Symptoms, Incidence, and Risk Factors of Portal Vein Thrombosis After Laparoscopic Sleeve Gastrectomy

Background/aim The rate of reported portal vein thrombosis (PVT) has increased over the past decade, coinciding with the rise in gastric sleeve resections. This study aimed to determine the incidence, risk factors, and presenting symptoms of PVT among patients who underwent laparoscopic sleeve gastrectomy (LSG). Methods A retrospective medical chart review was conducted for all adult patients who underwent LSG at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, between January 2016 and December 2020. Data were collected on patients' sociodemographic characteristics, presenting symptoms, comorbidities, thromboembolic events, medications, smoking status, PVT incidence and subtypes, onset, and time to diagnosis post-LSG. Statistical tests of association were used to identify risk factors associated with PVT. Results A total of 495 patients were included (170 males [34.3%] and 325 females [65.7%]), with a mean age of 38.1 ± 12.4 years. PVT occurred in 15 (3.0%) patients. The median time to onset was 14 days. The most common presenting symptoms were diffuse abdominal pain (46.7%), epigastric pain (33.3%), and nausea/vomiting (20.0%). Additional symptoms included right upper quadrant pain, flank pain, and bleeding from the surgical drain. PVT primarily involved the main portal trunk (66.7%) and intrahepatic branches (53.3%). A history of thromboembolic disease was significantly associated with PVT (13.3% vs. 1.9%; p = 0.038). No significant associations were found between PVT and gender (p = 0.639), age (p = 0.972), comorbidities (p > 0.05), smoking (p = 0.672), or medication use (p > 0.05). Conclusion The incidence of PVT in this cohort was 3.0%, higher than what has been reported in previous literature. The most common symptom was diffuse abdominal pain. Due to the non-specific nature of the symptoms, clinicians should maintain a high index of suspicion, especially in patients with a history of thromboembolic disease, to facilitate early diagnosis using noninvasive imaging and timely treatment of this potentially life-threatening complication.