Unraveling Postoperative Bleeding Dynamics in Laparoscopic Roux-en-Y Gastric Bypass: Insights from a Single-Center Tranexamic Acid Study.

Autor: Lo HC; Division of Trauma and Emergency Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. carfishcat@yahoo.com.tw.; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. carfishcat@yahoo.com.tw.; TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan. carfishcat@yahoo.com.tw., Hsu SC; Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.; Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.; Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan., Soong RS; Division of General Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, No.111 Sec.3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan.; College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, 110, Taiwan.; Division of Transplantation Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.; TMU Research Center for Organ Transplantation, Taipei Medical University, College of Medicine, Medical University, Taipei, Taiwan.; Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan., Huang SK; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.; Johns Hopkins Asthma and Allergy Center, Johns Hopkins University School of Medicine, Baltimore, USA.
Jazyk: angličtina
Zdroj: Obesity surgery [Obes Surg] 2024 Aug; Vol. 34 (8), pp. 3012-3020. Date of Electronic Publication: 2024 Jul 22.
DOI: 10.1007/s11695-024-07411-1
Abstrakt: Background: The efficacy of postoperative tranexamic acid (TXA) administration in mitigating bleeding after primary laparoscopic Roux-en-Y gastric bypass (RYGB), a prevalent complication associated with significant morbidities and mortality, and the use of sequential laboratory parameter changes in bleeding screening and TXA impact tracking were investigated.
Methods: This retrospective analysis included RYGB patients (aged 18-65 years, with a body mass index of 35-50 kg/m 2 ) over 5 years who were categorized into three groups by evolving treatment regimens: Group A (n = 42) received standard pre- and postoperative enoxaparin (30 mg) every 12 h; Group B (n = 160) received enoxaparin and postoperative TXA (250 mg every 6 h); and Group C (n = 73) received TXA alone. Postoperative bleeding-related adverse events, vital signs, and laboratory changes were compared.
Results: Postoperative hemorrhage occurred in 3.6% (10/275) of patients, with no significant intergroup differences. Patients who experienced bleeding had greater decreases in hemoglobin (∆Hb) (2.1 vs. 1.4; p = 0.003), greater ∆Hb > 2 (50% vs. 15%; p = 0.013), and greater use of staples than did those who did not experience bleeding (8 vs. 7; p = 0.001). The ∆Hb values were lower in Groups B (1.4) and C (1.3) than in Group A (1.7, p = 0.011). No significant difference was noted between Groups C and B.
Conclusion: This study emphasizes the potential of TXA to mitigate postoperative bleeding after RYGB, with no added benefit from excluding enoxaparin. Monitoring patients with a ∆Hb > 2 mg/dl and increased stapler usage is crucial. Further research is needed to validate routine TXA use across different procedures.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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