Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200013
Jornal Vascular Brasileiro
Case Report

Trombose da veia porta em gastrectomia vertical laparoscópica: série de casos

Portal vein thrombosis in laparoscopic vertical gastrectomy – laparoscopic sleeve gastrectomy: a case series

Jorge Oliveira da Rocha Filho; Paula Dayana Matkovski; Fabrício Martins Zucco; Bernardo Dalago Ristow; Patrícia Moraes; Felipe José Koleski; Rinaldo Danesi Pinto; Flávio Silvério de Almeida Ponce

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Resumo

Resumo: A obesidade grau III é definida como acúmulo excessivo de gordura no corpo, caracterizada por IMC > 40kg/m2 e está relacionada a uma série de comorbidades, sendo, por isso, de fundamental importância a adoção de um tratamento adequado para reduzir os efeitos deletérios na saúde do indivíduo. A gastrectomia vertical laparoscópica está bem estabelecida para o tratamento. Entre as complicações pós-operatórias possíveis, a trombose da veia porta destaca-se, apesar de rara. Em nosso estudo, foram analisados oito casos de pacientes submetidos à gastrectomia vertical laparoscópica que apresentaram como complicação pós-operatória o desenvolvimento de trombose da veia porta. Observamos em nossa série o aumento na incidência de trombose venosa portomesentérica, especialmente nos pacientes que não seguiram as recomendações de hidratação via oral no pós-operatório. A maioria dos pacientes com essa complicação responde de maneira positiva à anticoagulação, com recanalização completa ou parcial da porta. O tratamento com anticoagulantes mostra-se eficaz, devendo ser considerado como primeira opção. A hidratação vigorosa também tem se mostrado conduta essencial no pós-operatório desses pacientes, devendo ser sempre estimulada.

Palavras-chave

gastrectomia, trombose venosa, obesidade mórbida

Abstract

Grade III obesity is defined as excessive accumulation of fat in the body in a person with a BMI>40kg/m2 and is related to a series of comorbidities. It is therefore of fundamental importance that appropriate treatment is adopted to reduce its harmful effects on health. Laparoscopic vertical gastrectomy is well-established for treatment of grade III obesity. Although rare, portal vein thrombosis is one of the most serious of possible postoperative complications. In our study, eight cases are analyzed of laparoscopic vertical gastrectomy patients who developed portal vein thrombosis as a postoperative complication. In our series, we observed an increase in the incidence of portomesenteric venous thrombosis, especially among patients who did not follow the recommendations for oral hydration in the postoperative period. Most patients with this complication respond positively to anticoagulation, with complete or partial recanalization of the portal vein. Treatment with anticoagulants is effective and should be considered the first option. Vigorous hydration has also been shown to be an essential conduct in the postoperative period of these patients, and should always be encouraged.

Keywords

gastrectomy; venous thrombosis; morbid obesity

References

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