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Background: Portomesentric vein thrombosis (PMVT) is a rare but potentially serious and life threatening complication that may happen following laparoscopic bariatric surgery (LBS). Multifactorial local and systemic prothrombotic factors have been identitfied for PMVT development. In this study we intend to assess: 1) Incidence of PMVT post LBS in our patients’ population; 2) Our protocol for DVT prophylaxis with applying the enhanced recovery after surgery (ERAS) protocol and application of certain intra-operative techniques in PMVT prevention following LBS. Methods: This is a retrospcetive review of patients who underwent LBS between February 2011 and December 2016, who developed PMVT following LBS. Patients’ charts were reviewed and data were extracted (patients’ demographics, associated comorbidities, potential PMVT risk factors, LBS procedure undertaken, peri-operative details). In addition, the clinical features were also retrieved (PMVT presenting symptoms, management, blood investigations and thrombophilia screening). Results: Out of 3527 patients who underwent LBS in our center during this period, 4 patients developed PMVT comprising an incidence of 0.1%. Thrombophilic work up of patients who developed PMVT revealed that all had thrombosis risk factors (hyper-homocysteinema, anti-nuclear antibody, SLE, mutant Factor V Leiden, Protein C, Protein S deficiency). All managed medically and none required surgical intervention. There was no mortality. Conclusion: Though no consensus concerning PMVT prophylaxis in LBS patients exists, we propose that application of a standard multimodal thromboembolic prophylaxis mainly mechanical prophylaxis, intra-operative techniques and ERAS principles as showed, were major reasons for low PMVT incidence. All patient who developed PMVT post LBS had positive diagnostic throbophilia work up. Following standardized non-pharmacological thromboembolic prophylaxis in LBS patients questions the benefit of pharmacological thromboembolic prophylaxis. Background Thrombosis of portal vein and mesentric vein (Porto Mesenteric Venous Thrombosis, PMVT) is fortunatley a relatively uncommon complication in laparascopic bariatric surgery (LBS) patients [1]. However, PMVT requires prompt attention as delayed diagnosis could have potentially life-threatening consequences. For instance, PMVT accounts for 5-15% of reported cases of acute mesenteric ischemia, which could progress to bowel necrosis and sepsis, ultimately leading to death [2]. PMVT has been observed after surgical procedures, but the inflammatory and hypercoagulable obese state, laparoscopy, and manipulation of the portomesenteric venous system contribute to the increased risk of PMVT after LBS [3,4]. PMVT post laparoscopic Roux-en-Y gastric bypass (LRYGB) was first reported in 2004 and post laparoscopic sleeve gastrectomy (LSG) in 2009 [5]. Diagnosing PMVT is challenging in the obese patients post LBS period, with vague and non-specific symptoms and complaints [6]. Multiple diagnostic modalities are usually employed to establish the diagnosis e.g. CT scan, doppler ultrasound and MRI [7].Currently with the advancement in testing for hypercoagulable states, patients diagnosed with PMVT can undergo additional investigations to identify possible predisposing risk factors to thrombus formation. Such risk factors include factor V Leiden mutation, prothrombin G20210A mutation, protein S deficiency, protein C deficiency, antithrombin-III deficiency, activated protein C resistance and antiphospholipid syndrome which have all been linked to increased splanchnic thrombosis [8]. Review of the literature revealed a limited number of case reports and series describing PMVT following laparoscopic bariatric surgery as an uncommon complication [4]. A retrospective anaylsis of 1713 patients who have undergone LSG showed an incidence of 1% PMVT [1]. In our study we present the cases of PMVT following LBS performed at our Metabolic and Bariatric Surgery Center to assess our Moamena Ahmed El-Matbouly1*, Nesreen Khidir2, Davit Sargsyan1, Walid El Ansari3, Moataz Bashah1 and Mohammed Al-Kuwari1 1Department of General Surgery, Hamad Medical Corporation, Doha, Qatar 2Department of bariatric and metabolic Surgery, Hamad Medical Corporation, Doha, Qatar 3Department of Surgery, Hamad Medical Corporation, Doha, Qatar *Address for Correspondence Moamena Ahmed El-Matbouly, Department of General Surgery, Hamad Medical Corporation, Doha, Qatar, Tel: +974-55910445; E-mail: momenaelmatbouly@gmail.com Submission: 19 April, 2018 Accepted: 21 May, 2018 Published: 31 May, 2018 Copyright: © 2018 El-Matbouly MA, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Research Article Open Access

Portomesentric Vein Thrombosis: Our Experience of 3527 Laparoscopic Bariatric Surgery Procedures in Qatar