Splanchnic Vein Thrombosis after Metabolic and Bariatric Surgery: Chilean Position Statement of Hepatology and Bariatric Surgery societies.

BACKGROUND & AIMS: Metabolic and bariatric surgery is one of the most effective interventions for long-term weight loss and metabolic improvement. Splanchnic Vein Thrombosis (SVT) is an uncommon but potentially severe complication with a complex and multidisciplinary management, yet no clinical practice guidelines currently exist in this setting. We aimed to provide practical recommendations to guide healthcare teams in the prevention, diagnosis, and management of SVT after metabolic and bariatric surgery.

METHODS

A modified Delphi process was conducted in two rounds among 17 experts (seven hepatologists, seven bariatric surgeons, and three interventional radiologists). Statements were generated based on a structured literature review. After the Delphi rounds, statements were refined considering rate and comments. Consensus was predefined as ≥ 80% agreement.

RESULTS

Consensus was reached on seven dimensions of 20 statements (response rate R1 100% and R2 100%): (1) Risk factors related to surgical technique predisposing to SVT; (2) Assessment of candidates for metabolic and bariatric surgery; (3) Diagnosis of SVT; (4) Initial management of acute SVT; (5) Follow-up strategy for patients with SVT; (6) Late complications of SVT; (7) Prophylactic measures to prevent SVT. Recommendations emphasize the need for individualized surgical planning, comprehensive preoperative assessment for thrombotic risk factors, and multidisciplinary management. Additional statements addressed optimal diagnostic imaging, anticoagulation duration, and interventional radiology approaches for refractory or complicated cases.

CONCLUSIONS

This consensus provides structured, evidence-informed recommendations for the clinical assessment and management of SVT after metabolic and bariatric surgery. These statements are intended to standardize practice, support multidisciplinary decision-making, and improve patient outcomes in this rare but serious complication.