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
ARTICLE HIGHLIGHTS
Research background

Recently, many digestive surgical procedures are being performed laparoscopically. However, the effect of antithrombotic therapy (ATT) on perioperative bleeding complications during laparoscopic surgery is still largely unclear.

Research motivation

The risk of bleeding complications in ATT is related to the perioperative use of antiplatelet therapy (APT) or anticoagulation therapy (ACT). To safely perform laparoscopic digestive surgery in patients with ATT, optimal perioperative management of antithrombotic drugs should be established.

Research objectives

The main objective of the present study is to elucidate the effect of ATT on bleeding and thromboembolic complications during or after laparoscopic digestive surgery.

Research methods

Published articles or internationally accepted abstracts between 2000 and 2017 were searched, and studies involving laparoscopic digestive surgery and ATT were included after careful review of each study. Data including study design, type of surgical procedures, type of antithrombotic drugs, and surgical outcome were analyzed.

Research results

In total, 15 studies were included. Only one study concerning laparoscopic cholecystectomy showed that patients with heparin bridging for ACT had a higher risk of postoperative bleeding. The remaining 14 studies reported continued APT or that heparin bridging for ACT did not affect the incidence of bleeding complication. The risk of thromboembolic events after laparoscopic digestive surgery in patients receiving ATT was not significantly higher than those with no ATT or interrupted APT.

Research conclusions

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.

Research perspectives

The definite protocol or guidelines should be established using reliable studies with good design. In the future, a well-designed prospective randomized study or multicenter cohort study is mandatory to elucidate the safety and feasibility of laparoscopic digestive surgery.