**7. Laparoscopic surgery**

The expanding use of laparoscopy last 3 decades has profoundly changed surgical diagnosis and therapy. However there is still some controversy over the best practice for prevention of deep vein thrombosis (DVT) during laparoscopic surgery. There is considerable uncertainty related to the thromboembolic risk after laparoscopic procedures, and the use of thromboprophylaxis is controversial. Surgical trauma is generally less with laparoscopic than with open abdominal surgery, but activation of the coagulation system is similar to or only slightly less with laparoscopic procedures. Laparoscopic operations may be associated with longer surgical times than comparable open procedures. Both pneumoperitoneum and the reverse Trendelenburg position reduce venous return from the legs, creating venous stasis. Patients undergoing laparoscopic procedures may have shorter hospital stays, but they may not mobilize more rapidly at home than those who have had open procedures.

Despite the paucity of evidence, the European Association for Endoscopic Surgery has recom mended that intraoperative IPC be used for all prolonged laparoscopic procedures (66). In 2006, the Society of American Gastrointestinal Endoscopic Surgeons recommended the use of similar thromboprophylaxis options for laparoscopic procedures as for the equivalent open surgical procedures (67). However, available evidence does not support a recommendation for the routine use of thromboprophylaxis in these patients (68,69,70). Furthermore, with anticoagulant thromboprophylaxis, the risk of major bleeding may exceed the rate of thrombotic complications(71). Patients who are at particularly high thromboembolic risk can be considered for thromboprophylaxis with any of the modalities currently recommended for surgical patients (3,72).
