Surreal illustration of laparoscopic surgery with stylized blood cells and clock motif.

Laparoscopic Fundoplication: Minimizing Blood Clot Risks During Surgery

Soraya Malik in Health & Wellness November 2025 • 4 min read.

"A new study explores how timing anticoagulant treatment can reduce hypercoagulability during laparoscopic fundoplication."

Laparoscopic fundoplication, a minimally invasive surgery used to treat gastroesophageal reflux disease (GERD) and hiatal hernias, offers numerous benefits, including smaller incisions and faster recovery times. However, like all surgical procedures, it carries potential risks, one of the most significant being venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE).

Venous thromboembolism occurs when blood clots form in the veins, potentially leading to severe complications. During laparoscopic fundoplication, factors such as prolonged surgery time, the use of pneumoperitoneum (inflating the abdomen with gas), and the patient's positioning can increase the risk of blood clot formation. Therefore, strategies to minimize this risk are crucial for ensuring patient safety and optimal outcomes.

Anticoagulant medications, like low-molecular-weight heparin (LMWH), play a vital role in preventing blood clots. However, the timing of LMWH administration can significantly impact its effectiveness. A recent study published in "Videosurgery Miniinv" investigated the optimal timing of LMWH to reduce the risk of hypercoagulability—an increased tendency to form blood clots—during and after laparoscopic fundoplication. The research provides valuable insights into how strategic timing can enhance patient safety and improve surgical outcomes.

Understanding the Study: Anticoagulant Timing and Blood Clot Prevention

Surreal illustration of laparoscopic surgery with stylized blood cells and clock motif.

A study was conducted to determine the effect of antithrombotic prophylaxis on thromboelastogram results and development of venous thrombosis during laparoscopic fundoplication. The study, involved 106 patients undergoing laparoscopic fundoplication. Patients were divided into two groups to compare the effectiveness of different LMWH administration schedules.

The first group received LMWH 12 hours before surgery and then again 6 and 30 hours post-operation. The second group received LMWH only 1 hour before the procedure. Thromboelastography (TEG), a method to measure the coagulation properties of blood, was performed on all participants at three specific times:

Before LMWH injection.
One hour after the introduction of the laparoscope.
Fifteen minutes after the completion of the surgery.

Researchers then analyzed the TEG results to assess the impact of these different LMWH administration strategies on the patients' coagulation status. The goal was to identify which timing protocol better minimized the risk of hypercoagulability and subsequent VTE.

Strategic Anticoagulation: A Step Towards Safer Surgery

This study highlights the importance of carefully timing anticoagulant administration in patients undergoing laparoscopic fundoplication. By administering LMWH closer to the surgery (1 hour before), the hypercoagulation state induced by the procedure can be more effectively managed, potentially reducing the risk of postoperative thrombotic events. While more research is always valuable, these findings offer practical insights that can immediately impact clinical practice, leading to safer and more successful surgical outcomes.

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This article is based on research published under:

DOI-LINK: 10.5114/wiitm.2017.66474, Alternate LINK

Title: Thromboelastographic Changes During Laparoscopic Fundoplication

Subject: Urology

Journal: Videosurgery and Other Miniinvasive Techniques

Publisher: Termedia Sp. z.o.o.

Authors: Indre Zostautiene, Kristina Zvinienė, Darius Trepenaitis, Rolandas Gerbutavičius, Antanas Mickevičius, Rima Gerbutavičienė, Mindaugas Kiudelis

Published: 2017-01-01

Everything You Need To Know

What is laparoscopic fundoplication and why is it performed?

Laparoscopic fundoplication is a minimally invasive surgical procedure primarily used to treat gastroesophageal reflux disease (GERD) and hiatal hernias. It involves making small incisions and using specialized instruments to repair the stomach and reduce acid reflux. While it offers benefits like faster recovery, it's crucial to manage the risk of venous thromboembolism (VTE).

Why is venous thromboembolism (VTE) a concern during laparoscopic fundoplication?

Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a significant risk during laparoscopic fundoplication. These conditions occur when blood clots form in the veins, potentially leading to severe complications. Factors like prolonged surgery time and patient positioning can increase this risk, making preventive strategies essential.

What role do anticoagulant medications play in laparoscopic fundoplication?

Anticoagulant medications, such as low-molecular-weight heparin (LMWH), are crucial for preventing blood clots during and after laparoscopic fundoplication. The timing of LMWH administration can significantly impact its effectiveness in reducing hypercoagulability, an increased tendency to form blood clots. Strategic timing can enhance patient safety and improve surgical outcomes.

Can you explain the study that investigated anticoagulant timing during laparoscopic fundoplication?

The study published in "Videosurgery Miniinv" investigated the impact of low-molecular-weight heparin (LMWH) administration timing on hypercoagulability during laparoscopic fundoplication. It compared administering LMWH 12 hours before surgery versus 1 hour before. Researchers used thromboelastography (TEG) to measure blood coagulation properties and found that administering LMWH closer to the surgery (1 hour before) more effectively managed hypercoagulation.

What is thromboelastography (TEG) and how is it used in the context of laparoscopic fundoplication?

Thromboelastography (TEG) is a method used to assess the coagulation properties of blood. In the context of laparoscopic fundoplication, TEG is employed to monitor a patient's coagulation status before, during, and after the procedure. By analyzing TEG results, clinicians can determine the impact of anticoagulant administration strategies on the risk of hypercoagulability and subsequent venous thromboembolism (VTE).