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**4** 

*Greece* 

**Venous Thromboembolism in Bariatric Surgery** 

Deep venous thrombosis (DVT) and pulmonary embolism (PE) constitute clinical presentations of the same vascular disease, known as venous thromboembolism (VTE). VTE is responsible for hospitalization of >250000 Americans annually. It is associated with high morbidity and mortality and represents a primary cause of preventable death. There is strong evidence that obesity is an independent risk factor for DVT and PE. Bariatric surgery is proven to be an effective means in the therapy of morbid obesity and its related comorbidities, thus its prevalence is rapidly increasing. Well established and widely performed procedures include laparoscopic adjustable gastric band (LAGB), Roux-en-Y gastric bypass (RYGBP), biliopancreatic diversion (BPD, with or without duodenal switch) and sleeve gastrectomy (SG). LAGB is a purely restrictive method, while RYGBP and BPD are considered as mainly malabsorbptive procedures. SG was performed as a bridge to further by-pass surgery, however nowadays is performed as a single stage procedure. The risk of VTE in patients undergoing elective bariatric surgery is high, attributable to obesity, intraoperating factors and the lack of an established guidance describing optimal VTE prophylaxis. Overall incidence of VTE in this population is reported to be 1-3%. Diagnosis of PE postoperatively in obese patients can be difficult due to physical limitations and consequently may be underdiagnosed. Furthermore, although VTE is usually diagnosed as immediate postoperative complication, PE can occur in nonhospitalized patients, within the

The most widely applied tool to diagnose obesity is body mass index (BMI). BMI is defined as weight in kilograms divided by the square of height in meters. World health Organization defines obesity as a BMI≥ 30. This cutoff was selected because according to epidemiological studies mortality curve increases at this value. Moreover, morbid obesity is

The prevalence of obesity increases rapidly in both developed and developing countries and

Recent scientific data from long-term studies support the strong association between obesity and type 2 diabetes, hypertension, cardiovascural disease, dyslipidemia, arthritis, gallbladder disease, sleep apnea syndrome and many types of cancer. Furthermore, obesity

first month after surgery, despite pharmacologic prophylaxis.

is considered as one of the most serious public health problems.

deteriorates quality of life and induces severe psychological disorders.

**1. Introduction**

**2. Obesity** 

defined as BMI≥40.

Eleni Zachari, Eleni Sioka, George Tzovaras and Dimitris Zacharoulis

 *Department of Surgery, University Hospital of Larissa* 

