Blood coagulation changes in laparoscopic gastrectomy: morbid obese vs normal patients

Kim, Yong Suk; Joo, Jin; Ryu, Keon Hee; Lim, Dae Hwan; Park, Chul Soo

Clinical Research

General Article

Anesthesia and Pain Medicine 2012;7(1):97-102.
Published online January 31, 2012.

Blood coagulation changes in laparoscopic gastrectomy: morbid obese vs normal patients

Yong Suk Kim, Jin Joo, Keon Hee Ryu, Dae Hwan Lim, Chul Soo Park

Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. p6c8s17@catholic.ac.kr

Abstract

BACKGROUND
Patients with morbid obesity have higher risk of fatal thromboembolic episodes than non-obese patients. We aimed to identify perioperative changes in blood coagulation for the patients undergoing bariatric surgery and compare thromboelastography (TEG) findings with non-obese patients.
METHODS
24 patients with morbid obesity (group B) and 22 patients with stomach cancer (group S) who undergoing laparoscopic Roux-en-Y gastric bypass surgery were prospectively studied. Laboratory coagulation-related tests and TEG were conducted immediately after anesthetic induction (T0), at 2 hours after surgical incision (T1), and 2 hours after the end of surgery (T2).
RESULTS
Group B had higher serum lactate, fibrinogen, maximum amplitude in TEG findings, and shorter activated partial thromboplastin time (aPTT) than group S at T0 (P < 0.05). In group B, serum fibrinogen degradation products (FDP) at T2 and base deficit at T1 and T2 were higher, and aPTT was shorter than those at T0 (P < 0.05). R-time and k-time showed gradual shortening toward T2. alpha-angle at T1 and coagulation index at T2 increased significantly from those at T0 in the group B (P < 0.05). However, group B failed to show any significant differences from the group S in TEG and coagulation-related laboratory findings except platelet count and serum fibrinogen level at T1 and T2.
CONCLUSIONS
Preoperatively, morbidly obese patients had more activated coagulation profiles than non-obese patients. However, remarkable perioperative changes in TEG findings could not be definitely observed between two groups.

Key Words: Bariatric surgery, Hypercoagulability, Thromboelastography