Towards zero bleeding after laparoscopic sleeve gastrectomy: investigating the impact of prophylactic tranexamic acid

Owaid M. Almalki

doi:10.18203/2349-2902.isj20241307

Authors

Owaid M. Almalki Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia; Department of Surgery, Alhada Military Hospital, Taif, Saudi Arabia

DOI:

https://doi.org/10.18203/2349-2902.isj20241307

Keywords:

Tranexamic acid, TXA, Laparoscopic sleeve gastrectomy, Gastric sleeve surgery, Complications, Stable line bleeding, Postoperative bleeding

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) is a prevalent bariatric procedure known for its efficacy in weight loss and amelioration of obesity-related comorbidities. However, postoperative bleeding from the staple line remains a significant complication, necessitating strategies for effective hemostasis. Tranexamic acid (TXA) has shown promise in reducing bleeding complications in various surgical contexts, yet its role in LSG remains underexplored due to concerns about thromboembolic risks.

Methods: This retrospective comparative analysis examines the impact of prophylactic TXA administration on perioperative bleeding in LSG patients. Two cohorts of 100 patients each, undergoing LSG before and after TXA implementation, were analyzed. Demographic, clinical, and outcome data were collected and statistically analyzed.

Results: In our study, 100 patients received TXA with a mean age of 36.8±12.18 years, while another 100 formed the non-TXA group with a mean age of 37.2±11.81 years. Pre-surgery, clinical characteristics and hemodynamic parameters did not significantly differ between groups. However, post-surgery, TXA patients showed significantly elevated hemoglobin levels (p=0.019), increased hematocrit (p<0.001), higher prothrombin activity (p=0.002), decreased INR values (p=0.012), and higher fibrinogen levels (p=0.014) compared to non-TXA patients. Three non-TXA patients experienced post-operative bleeding requiring ICU admission and transfusions. The mean length of stay was 2.1±0.5 days for TXA patients and 2.2±0.03 days for non-TXA patients. No venous thromboembolism (VTE) or deaths occurred in either group.

Conclusions: The integration of prophylactic TXA into perioperative protocols for LSG holds promise in optimizing hemostasis and enhancing patient outcomes. TXA serves as a valuable adjunctive strategy towards minimizing bleeding events and bolstering safety in LSG procedures.

Metrics

Metrics Loading ...

References

Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis. 2014;10(4):713-23.

Kumar SB, Hamilton BC, Wood SG, Rogers SJ, Carter JT, Lin MY. Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? A comparison of 30-day complications using the MBSAQIP data registry. Surg Obes Relat Dis. 2018;14(3):264-9.

Ponce J, Demaria EJ, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis. 2016;12(9):1637-9.

Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822-32.

Rebibo L, Dhahri A, Chati R, Cosse C, Huet E, Regimbeau J-M. Effectiveness of fibrin sealant application on the development of staple line complications after sleeve gastrectomy. Ann Surg. 2018;268(5):762-8.

Moon RC, Shah N, Teixeira AF, Jawad MA. Management of staple line leaks following sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(1):54-9.

Wang H, Lu J, Feng J, Wang Z. Staple line oversewing during laparoscopic sleeve gastrectomy. Ann R Surg Engl. 2017;99(7):509-14.

Chakravartty S, Sarma DR, Chang A, Patel AG. Staple line bleeding in sleeve gastrectomy—a simple and cost-effective solution. Obes Surg. 2016;26(7):1422-8.

Kirmizi S, Kayaalp C, Karagul S, Tardu A, Ertugrul I, Sumer F, et al. Comparison of Harmonic scalpel and Ligasure devices in laparoscopic Roux-en-Y gastric bypass. Wideochir Inne Tech Maloinwazyjne. 2017;12(1):28-31.

Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc Other Interv Tech. 2012;26(6):1509-15.

Wong T, Karkouti I, Hebert P. Association between tranexamic acid use and thromboembolic risk in total knee arthroplasty: a systematic review and meta-analysis. Thromb Haemost. 2017;117:981-90.

Myles PS, Myles T, Xiao F. Tranexamic acid for prevention of postoperative bleeding in cardiac surgery: systematic review and meta-analysis. BMJ. 2009;339:b3132.

Heesen PS, Blohm U, Götte C. Systematic review and meta-analysis of tranexamic acid in primary caesarean section to reduce blood loss. Br J Anaesth. 2014;113:64-77.

CRASH-2 trial collaborators; Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32.

Gagner M, Hutchinson C, Rosenthal R. Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2016;12:750-6.

Zafar SN, Felton J, Miller K, Wise ES, Kligman M. Staple Line Treatment and Bleeding After Laparoscopic Sleeve Gastrectomy. JSLS. 2018;22(4):e2018.

Hong P, Liu R, Rai S, Liu J, Ding Y, Li J. Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis. Front Pharmacol. 2022;13:887386.

Brito RM, Oliveira CMB, Moura ECR, Campelo GP, Lima RC, Fe CSM, et al. Tranexamic acid effects in postoperative bleeding outcomes in laparoscopic sleeve gastrectomy: a controlled study. Acta Cir Bras. 2022;37(7):e370702.

Lech P, Michalik M, Waczyński K, Osowiecka K, Dowgiałło-Gornowicz N. Effectiveness of prophylactic doses of tranexamic acid in reducing hemorrhagic events in sleeve gastrectomy. Langenbecks Arch Surg. 2022;407(7):2733-7.

Hossain N, Kaur V, Mahran M, Quddus A, Mukhopadhyay S, Shah A, et al. Intra-operative Tranexamic Acid Administration Significantly Decreases Incidence of Postoperative Bleeding Without Increasing Venous Thromboembolism Risk After Laparoscopic Sleeve Gastrectomy: a Retrospective Cohort Study of Over 400 Patients. Obes Surg. 2024;34(2):396-401.

McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs. 2012;72:585-617.

Picetti R, Shakur-Still H, Medcalf RL, Standing JF, Roberts I. What concentration of tranexamic acid is needed to inhibit fibrinolysis? A systematic review of pharmacodynamics studies. Blood Coagul Fibrinolysis. 2019;30(1):1-10.

Brito RM, Oliveira CMB, Moura ECR, Campelo GP, Lima RC, Servin ETN, et al. Comparison of tranexamic acid and stapling line reinforcement in laparoscopic sleeve gastrectomy in postoperative bleeding outcomes. Braz J Anesthesiol. 2023;73(3):361-3.

Aminian A, Vosburg RW, Altieri MS, Hinojosa MW, Khorgami Z; American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. The American Society for Metabolic and Bariatric Surgery (ASMBS) updated position statement on perioperative venous thromboembolism prophylaxis in bariatric surgery. Surg Obes Related Dis. 2022;18(2):165-74.

Alhomoud H. The effect of tranexamic acid on blood loss during laparoscopic sleeve gastrectomy. World J Laparosc Surg. 2016;9(1):30-3.