The Incidence of Pulmonary Embolism in Open versus Laparoscopic Gastric Bypass

Nicholas J. Gargiulo, Frank J. Veith, Evan C. Lipsitz, William D. Suggs, Takao Ohki, Elliot Goodman, Pratt Vemulapalli, Karen Gibbs, Julio Teixeira

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Obesity independently increases the risk of pulmonary embolism (PE). We compare a superobese population (body mass index [BMI] > 55 kg/m2) undergoing open gastric bypasses (OGBs) with a similarly matched group of laparoscopic gastric bypasses (LGB) to see if the incidence of PE differs. We included all patients undergoing OGB (n = 193, average BMI = 51 kg/m2) at our institution by a single surgeon between July 1999 and April 2001. Thirty-one patients were superobese (BMI > 55 kg/m2). LGB was started at our institution in April 2001. Since that time 213 patients (average BMI = 52 kg/m2) have undergone the procedure. One hundred and nine patients were superobese. Pre- and postoperative prophylaxis included sequential compression stockings and subcutaneous heparin. Postoperatively, patients who developed signs of hypoxia, tachypnea, or tachycardia underwent a chest X-ray and spiral computed tomography. In addition, all patients who expired in the 30-day postoperative period underwent postmortem examination. Data were analyzed using the chi-squared test. In the OGB group, four patients (2.1%) developed PE. All occurred in superobese patients with a BMI > 55 kg/m2. Three were fatal PEs and one was nonfatal. None of these patients had a prior history of deep vein thrombosis, PE, venous stasis disease, or pulmonary hypertension. In the LGB group, one patient (0.9%) had a nonfatal PE. This patient had a history of deep vein thrombosis. The incidence of PE was statistically higher in the superobese OGB group (P < 0.01). Despite the theoretical hindrance to venous return and vena caval compression observed with pneumoperitoneum, fewer PEs occurred in the laparoscopic group. Our data, however, suggest that patients with a BMI > 55 kg/m2 might be at an increased risk for PE independent of operative approach.

Original languageEnglish (US)
Pages (from-to)556-559
Number of pages4
JournalAnnals of Vascular Surgery
Volume21
Issue number5
DOIs
StatePublished - Sep 1 2007

    Fingerprint

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Gargiulo, N. J., Veith, F. J., Lipsitz, E. C., Suggs, W. D., Ohki, T., Goodman, E., Vemulapalli, P., Gibbs, K., & Teixeira, J. (2007). The Incidence of Pulmonary Embolism in Open versus Laparoscopic Gastric Bypass. Annals of Vascular Surgery, 21(5), 556-559. https://doi.org/10.1016/j.avsg.2007.07.003