Background

Laparoscopic sleeve gastrectomy (LSG) has gained significant popularity in recent years as one of the leading weight-loss procedures in the U.S. due to its reported effectiveness and relatively low risk. One of its notable advantages is a low incidence of complications, however, portal vein thrombosis (PVT) has emerged as a potential complication, with a reported incidence of 0.419%. In this report, we present a case series documenting four instances of PVT following LSG at our institution. Notably, all cases manifested within four weeks postoperatively in patients devoid of any prior history of deep venous thrombosis (DVT) or prothrombotic risk factors. The patients, aged between 34 and 56, exhibited an average BMI of 46, and the predominant presenting symptom was abdominal pain. Diagnosis was confirmed through abdominal CT scans, with subsequent treatment involving systemic anticoagulation. Following treatment, all patients were discharged with oral anticoagulation, with an average duration of three weeks. Notably, no formal hypercoagulable state was identified beyond recent surgery.Research suggests that the incidence of PVT post-bariatric surgery is lower in patients who undergo extended postoperative prophylactic anticoagulation (AC). Given the rarity of PVT as a complication following bariatric surgery, heightened vigilance is essential, particularly after LSG. Clinicians should be mindful of this potential complication, implementing perioperative AC protocols and considering postoperative AC protocols, even in low to moderate-risk bariatric patients. A multidisciplinary approach to the treatment of PVT is recommended to ensure comprehensive care and management.