Is IVC Filter Insertion Required Prior to Robotic Gastric Bypass in Super-Obese (BMI > 55 kg/m2) Patients?
Nicholas J. Gargiulo, III, MD FACS, Frank J. Veith, MD FACS, Evan C. Lipsitz, MD FACS, Neal Cayne, MD FACS, Greg Landis, MD FACS.
Clinch Valley Medical Center, Richlands, VA, USA.
Background: It has been previously suggested that inferior vena cava (IVC) filter placement at the time of open gastric bypass in patients with a body mass index (BMI) > 55 kg/m2 reduces both the pulmonary embolism rate and perioperative mortality. This has not been observed in patients undergoing laparoscopic gastric bypass. Little is known regarding the necessity of IVC filter placement in patients undergoing robotic gastric bypass surgery.
Methods: Over a 3 year period, 51 morbid obese patients have undergone robotic gastric bypass procedures, and 37 (72.5%) had a BMI > 55 kg/m2. All 51 patients had routine preoperative subcutaneous lovenox injections and systemic compression devices prior to the administration of general anesthesia. Robotic gastric bypass was completed utilizing the da Vinci system.
Results: Fifty of 51 (98%) patients remained free of thrombo-embolic phenomena over the 3 year period (range 6 months-3 years) following successful robotic gastric bypass with the da Vinci system. One patient (2%) with a BMI > 55 kg/m2 developed a pulmonary embolism (PE) 1 month post procedure. She was treated successfully with intravenous heparin and had complete resolution of the PE. She was incidentally diagnosed with a Factor V Leiden deficiency and placed on long-term oral anticoagulation.
Conclusions: It appears that IVC filter placement at the time of robotic gastric bypass is not required even in patients with a BMI > 55 kg/m2. A note of caution should be exerted in those obese patients who have a hypercoagulable disorder. An aggressive posture should be advocated in this small sub-group of morbid obese patients which may consist of immediate anticoagulation (when it is deemed safe) following their procedures.
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