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The incidence of deep venous thrombosis after laparoscopic cholecystectomy
M I Patel1, D T Hardman, D Nicholls
1Department of Vascular Surgery, Royal North Shore Hospital, Sydney, NSW.
Objective:
To determine the incidence of deep venous thrombosis (DVT) after laparoscopic cholecystectomy.
Design:
Prospective cross-sectional analysis, with a one-month follow-up, conducted in 1994.
Setting:
University teaching hospital.
Subjects:
20 patients undergoing elective or urgent laparoscopic cholecystectomy, consecutively recruited.
Interventions:
Patients received thromboprophylaxis according to the normal practice of the attending surgeon and underwent laparoscopic cholecystectomy. A venous duplex scan was performed before the operation and on Day 1, 7 and 30 after the operation.
Main Outcome Measure:
The presence of postoperative DVT.
Results:
All patients were given graduated compression stockings to wear and 16 received electrical stimulation of the calf during the operation. Only 16 patients received pharmacological thromboprophylaxis before the operation, but all patients received this after the operation. The median duration of pneumoperitoneum was 80 minutes (40-160 minutes). Eleven of 19 patients completing all the required scans developed venous thrombosis (incidence, 55%); in three the thromboses involved major axial veins. In one patient the Day 7 and Day 30 scans were not performed, but the Day 1 scan was negative. Seven of the 11 thromboses were detected on the Day 1 scan. None of the DVTs were suspected clinically.
Conclusions:
This extremely high incidence of venous thrombosis correlates with the haemodynamic changes which occur in the venous system during pneumoperitoneum. Laparoscopic cholecystectomy should not be considered a procedure with a low risk of DVT, and further studies are needed to determine optimal DVT prophylaxis for laparoscopic surgery.