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The incidence of deep venous thrombosis after laparoscopic cholecystectomy

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.