Portomesenteric vein thrombosis in patients undergoing sleeve gastrectomy: An updated meta-analysis of 101,865 patients

Background: Portomesenteric vein thrombosis (PMVT) is a rare but potentially fatal complication of sleeve gastrectomy (SG). The rising prevalence of SG has led to a surge in the occurrence of PMVT, while the associated risk factors have not been fully elucidated.Objectives: This study aims to determine the incidence and risk factors of PMVT in patients undergoing SG.Methods: A comprehensive literature search was performed in PubMed (MEDLINE) and EMBASE databases. Proportion and regression meta-analyses were conducted.Results: A total of 75 studies and 101,865 patients undergoing SG and 355 patients with PMVT were identified. At a mean follow-up of 14.4 (SD: 16.3) months the incidence of PMVT was found to be 0.48% (95%CI: 0.39-0.60%). The majority of the population presented with abdominal pain (91.8%) at an average of 22.4 days postoperatively and PMV was mainly diagnosed with CT scan (96.0%). Hematologic abnormalities predisposing to thrombophilia were identified in 34.9% of the population. Age (p=0.02) and center volume (p &lt;0.0001) were significantly associated with PMVT, while gender, BMI, hematologic abnormality, prior history of deep vein thrombosis or pulmonary embolism, type of prophylactic anticoagulation, and duration of prophylactic anticoagulation were not associated with the incidence of PMVT in meta-regression analyses. Treatment included therapeutic anticoagulation in 93.4% and the mortality rate was 4/355 (1.1%).Conclusion: PMVT is a rare complication of sleeve gastrectomy with an incidence rate &lt;1% that is associated with center volume and age but is not affected by the duration or type of thromboprophylaxis administered postoperatively.<br/

Liver Transplantation for Pediatric Hepatocellular Carcinoma: A Systematic Review

Liver transplantation (LT) is the only potentially curative option for children with unresectable hepatocellular carcinoma (HCC). We performed a systematic review of the MEDLINE, Scopus, Cochrane Library, and Web of Science databases (end-of-search date: 31 July 2020). Our outcomes were overall survival (OS) and disease-free survival (DFS). We evaluated the effect of clinically relevant variables on outcomes using the Kaplan&ndash;Meier method and log-rank test. Sixty-seven studies reporting on 245 children undergoing LT for HCC were included. DFS data were available for 150 patients and the 1-, 3-, and 5-year DFS rates were 92.3%, 89.1%, and 84.5%, respectively. Sixty of the two hundred and thirty-eight patients (25.2%) died over a mean follow up of 46.8 &plusmn; 47.4 months. OS data were available for 222 patients and the 1-, 3-, and 5-year OS rates were 87.9%, 78.8%, and 74.3%, respectively. Although no difference was observed between children transplanted within vs. beyond Milan criteria (p = 0.15), superior OS was observed in children transplanted within vs. beyond UCSF criteria (p = 0.02). LT can yield favorable outcomes for pediatric HCC beyond Milan but not beyond UCSF criteria. Further research is required to determine appropriate LT selection criteria for pediatric HCC