Despite improvements achieved over time in the overall safety of bariatric surgery, venous thromboembolism remains a major cause of mortality after bariatric surgery. This risk is especially high when patients are discharged from the hospital after a short length of stay. On top of this, the risk that patients undergoing laparoscopic sleeve gastrectomy face for developing portomesenteric venous thrombosis has, until recently, been unappreciated but now is starting to enter our awareness. The findings that Dr. Parikh reported on the prevalence of thrombophilia is notable. I certainly had no idea that half the patients who seek laparoscopic sleeve gastrectomy are in a thrombophilic state, often because of elevated factor VIII.

Vivek N. Prachand, MD , is professor of surgery and director of minimally invasive surgery at the University of Chicago. He had no disclosures. He made these comments as designated discussant for the report.