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Portomesenteric vein thrombosis (PVT) is a rare but serious complication following bariatric surgery and most frequently reported after sleeve gastrectomy. Identification of risk factors for PVT could allow targeted management strategies to potentially reduce this risk.


Using a state-wide bariatric-specific data registry, we identified all patients who underwent primary bariatric surgery between 2006 and 2021 (n=102,869). Patient characteristics, procedure type and 30-day postoperative complications were analyzed with multivariable logistic regression to evaluate for independent predictors of PVT.


A total of 117 patients (0.11%) developed a postoperative PVT with 12 (10.3%) associated deaths. The majority of PVTs occurred in patients who underwent sleeve gastrectomy (109, 93.2%) and most commonly occurred during the 2nd (37%), 3rd (31%), and 4th (23%) weeks after surgery. Independent risk factors for PVT included a prior history of venous thromboembolism (VTE) (OR 3.1, 1.64-5.98, p=0.0005), liver disorder (OR 2.3, 1.36-4.00, p=0.0021), undergoing sleeve gastrectomy (OR 12.4, CI 4.98-30.69, p<0.0001) and postoperative complications including obstruction (OR 12.5, CI 4.65-33.77, p<0.0001), leak (OR 7.9, CI 2.76-22.64 p=0.0001) and hemorrhage (OR 7.6, 3.57-16.06 p<0.0001).


Independent predictors of PVT include a prior history of VTE, liver disease, undergoing sleeve gastrectomy and experiencing a serious postoperative complication. Given that the incidence of PVT occurs most commonly within the first month after surgery, extending post-discharge chemoprophylaxis during this time frame is advised for patients with increased risk.