Systematic Reviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2018; 6(14): 767-775
Published online Nov 26, 2018. doi: 10.12998/wjcc.v6.i14.767
Safety of laparoscopic surgery in digestive diseases with special reference to antithrombotic therapy: A systematic review of the literature
Takahisa Fujikawa, Kenji Ando
Takahisa Fujikawa, Department of Surgery, Kokura Memorial Hospital, Kitakyushu 802-8555, Fukuoka, Japan
Kenji Ando, Department of Cardiology, Kokura Memorial Hospital, Kitakyushu 802-8555, Fukuoka, Japan
Author contributions: Fujikawa T designed, performed research and analyzed data; Fujikawa T prepared the manuscript and Ando K reviewed it.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takahisa Fujikawa, MD, PhD, Chief Doctor, Surgeon, Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu 802-8555, Fukuoka, Japan. fujikawa-t@kokurakinen.or.jp
Telephone: +81-93-5112000 Fax: +81-93-5113240
Received: May 31, 2018
Peer-review started: May 31, 2018
First decision: July 17, 2018
Revised: August 2, 2018
Accepted: October 17, 2018
Article in press: October 16, 2018
Published online: November 26, 2018
Abstract
AIM

To elucidate the effect of antithrombotic therapy (ATT) on bleeding and thromboembolic complications during or after laparoscopic digestive surgery.

METHODS

Published articles or internationally accepted abstracts between 2000 and 2017 were searched from PubMed, Cochrane Database, and Google Scholar, and studies involving laparoscopic digestive surgery and antiplatelet therapy (APT) and/or anticoagulation therapy (ACT) were included after careful review of each study. Data such as study design, type of surgical procedures, antithrombotic drugs used, and surgical outcome (both bleeding and thromboembolic complications) were extracted from each study.

RESULTS

Thirteen published articles and two internationally accepted abstracts were eligible for inclusion in the systematic review. Only one study concerning elective laparoscopic cholecystectomy in patients with perioperative heparin bridging for ACT showed that the risk of postoperative bleeding was higher compared with those without ACT. The remaining 14 studies reported no significant differences in the incidence of bleeding complications between the ATT group and the group without ATT. The risk of thromboembolic events (TE) associated with laparoscopic digestive surgery in patients receiving ATT was not significantly higher than those with no ATT or interrupted APT.

CONCLUSION

Laparoscopic digestive surgery in ATT-burdened patients for prevention of bleeding and TE showed satisfactory results. The risk of hemorrhagic complication during or after these procedures in patients with continued APT or heparin bridging was not significantly higher than in patients with no ATT or interrupted APT.

Keywords: Thromboembolic complication, Bleeding complication, Laparoscopic surgery, Anticoagulation therapy, Digestive surgery, Antithrombotic therapy, Antiplatelet therapy

Core tip: In total, 15 published articles and abstracts concerning laparoscopic digestive surgery and antithrombotic therapy were systematically reviewed. These articles demonstrated that the risk of bleeding and thromboembolic complications during or after these procedures in patients with continued antiplatelets or heparin bridging was not significantly higher than in patients with no antithrombotics or interrupted antiplatelets.