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Objective: To study the incidence of late deep venous thrombosis (DVT), and to evaluate a regimen of prolonged thromboprophylaxis after general surgery.Design: Randomised, controlled, open trial, with blinded evaluation.Setting: University hospital, Denmark.Subjects: 176 consecutive patients undergoing major elective abdominal or non-cardiac thoracic operations, of whom 118 were eligible for evaluation.Interventions: Thromboprophylaxis with a low-molecular-weight heparin, tinzaparin, given for four weeks (n ≥ 58), compared with one week (control group, n ≥ 60).Main outcome measures: Presence of DVT established by bilateral venography four weeks after the operation.Results: The incidence of late DVT in the control group was 6/60 (10%, 95% confidence interval (CI) 4% to 21%). In the prophylaxis group it was 3/58 (5.2%, 95% CI 1% to 14%) (p ≥ 0.49).Conclusion: Prolonged thromboprophylaxis had no significant effect on the incidence of DVT occurring late after general surgery.

Objective: To evaluate colour Doppler flow imaging ultrasonography (CDFI), compared with venography, as a screening method for postoperative deep venous thrombosis (DVT) in a clinical trial on thromboprophylaxis. Methods: Patients undergoing major abdominal or thoracic surgery were prospectively screened for DVT by CDFI. Patients were examined preoperatively, and on postoperative days 1, 3, 7, 14, 21, and 28. When the CDFI was positive venography was performed. Bilateral venography was performed on day 28 in all patients. The study group comprised 82 patients who underwent CDFI and venography on the same day: four because of suspected DVT (positive CDFI), and 78 on day 28 according to protocol. Results: DVT was detected by venography in seven patients, in three of whom CDFI was positive. CDFI was falsely positive in one case. There were two popliteal and five calf DVTs, of which CDFI detected one and two, respectively. The sensitivity of CDFI was 43%, the specificity 99%. The PVpos for CDFI was 75%, and the PVneg 96%. Conclusion: Due to low sensitivity, CDFI cannot stand alone as a screening method for asymptomatic postoperative DVT.

A successful balloon catheter dilatation of stenotic gastroduodenal anastomosis is reported. The timing of such postoperative dilatations is crucial for avoiding rupture of the anastomosis or — in the late phase of healing — hard fibrous tissue inhibiting the dilatation. It is recommended that balloon catheter dilatation be the procedure of choice before making a decision about a second look operation.