Nguyen NT, Owings JT, Gosselin R, Pevec WC, Lee SJ, Goldman C, Wolfe BM.
Systemic coagulation and fibrinolysis after laparoscopic and open gastric bypass.
Arch Surg 2001 Aug;136(8):909-16

Department of Surgery, University of California, Davis, Medical Center, 2221
Stockton Blvd, 3rd Floor, Sacramento, CA 95817-1418, USA.
ninh.nguyen@ucdmc.ucdavis.edu

HYPOTHESIS: Laparoscopic gastric bypass (GBP) induces a postoperative
hypercoagulable state that is similar or reduced compared with open GBP. SETTING:
University hospital. PATIENTS: Between May 1999 and June 2000, 70 patients were
randomly assigned to laparoscopic (n = 36) or open (n = 34) GBP. Deep venous
thrombosis (DVT) prophylaxis consisted of antiembolism stockings and sequential
pneumatic compression devices. MAIN OUTCOME MEASURES: Plasminogen,
thrombin-antithrombin complex (TAT), prothrombin fragment 1.2 (F1.2), fibrinogen,
D-dimer, antithrombin III (AT), and protein C levels were measured at baseline
and at 1, 24, 48, and 72 hours postoperatively. A venous duplex examination of
both lower extremities was performed preoperatively and between the third and
fifth day postoperatively. RESULTS: The 2 groups were similar in age, weight, and
body mass index. Plasminogen levels decreased, and TAT, F1.2, and fibrinogen
levels increased after laparoscopic and open GBP. There was no significant
difference in these levels between groups. D-dimer levels increased in both
groups, but the levels were significantly higher after open GBP than after
laparoscopic GBP (P<.01). Antithrombin III and protein C levels decreased in both
groups. The reduction of AT (at 1 hour) and protein C (at 72 hours) was
significantly less after laparoscopic GBP than after open GBP (P<.05).
Postoperative venous duplex examination revealed DVT in 1 (2.9%) of 34 patients
after open GBP but in none of 36 patients after laparoscopic GBP. One patient
developed pulmonary embolism after open GBP. CONCLUSIONS: Laparoscopic GBP
induces a hypercoagulable state similar to that of open GBP. Our findings suggest
that DVT prophylaxis should be used during laparoscopic GBP as in open GBP.