Pakistan Armed Forces Medical Journal (Oct 2018)
INCIDENCE OF DEEP VENOUS THROMBOSIS IN LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT THROMBOPROPHYLAXIS
Abstract
Objective: To determine the incidence of clinically detectable deep venous thrombosis (DVT) in patients undergoing laparoscopic cholecystectomy without a standard DVT prophylaxis regimen. Study Design: Prospective observational study. Place and Duration of Study: All the patients included in the study underwent laparoscopic cholecystectomy from Nov 2014 to Nov 2016 in Hepatobiliary department Pak Emirates Military Hospital Rawalpindi under general anaesthesia. Material and Methods: The study was carried out on 723 patients undergoing laparoscopic cholecystectomy. Data was collected on a specially designed proforma. Quantitative D-dimers and 3 risk stratification (Wells score) for deep venous thrombosis was done 24 hrs preoperatively 24 hrs, 72 hrs and 14 days postoperatively. Results: The study population comprised of 723 patients. Twenty seven patients were converted to undergo open cholecystectomy and were excluded from the study. Forteen patients were lost to follow-up. 03 pts with preop high probability of DVT were excluded from further postoperative screening. During postoperative screening, 05 out of 679 pts had a Wells score of more than 03, which showed a high probability of DVT in these patients. Out of these 05 pts, four had raised D-dimers as well. For definitive diagnosis, all these 05 patients underwent duplex scan, which confirmed deep venous thrombosis. Conclusion: We conclude that there is no significant risk of DVT after laparoscopic cholecystectomy. Thromboprophylaxis is not recommended in patients undergoing elective laparoscopic cholecystectomy without any risk factors of DVT. Preoperative risk stratification for DVT and D-dimers are effective screening tools for pts undergoing laparoscopic cholecystectomy.
