Successful Laparoscopic Sleeve Gastrectomy in a Patient With Rare Congenital Factor VII Deficiency: A Case Report and Management Strategy.

Congenital factor VII (FVII) deficiency is a rare coagulation disorder that increases the risk of bleeding complications during surgery. Although laparoscopic sleeve gastrectomy (LSG) is the most common metabolic bariatric surgery (MBS), it is rarely performed in patients with congenital coagulation disorders such as FVII deficiency, due to the high risk of intraoperative and postoperative bleeding. We report the case of a 57-year-old female with class II obesity (BMI 37.9 kg/m²) and previously undiagnosed congenital FVII deficiency presenting for LSG. The patient's prothrombin time-international normalized ratio (PT-INR) was elevated (2.3; normal range: 0.8-1.2) with a normal activated partial thromboplastin time (aPTT) and no known preexisting liver disease or use of anticoagulant medications. Further hematology workup confirmed isolated low FVII activity (11% of normal). Preoperative management included transfusion of two units of fresh frozen plasma (FFP) to correct the coagulopathy. Intraoperatively, 1000 international units (IU) of prothrombin complex concentrate (PCC) were administered before the end of surgery. The procedure proceeded uneventfully with no bleeding complications. Postoperatively, thromboprophylaxis with low molecular weight heparin (LMWH) was administered for 14 days without any bleeding episodes. This case demonstrates that with careful preoperative evaluation, appropriate correction of coagulopathy, and a multidisciplinary team approach, LSG can be safely performed in patients with congenital FVII deficiency. This report may serve as a reference for managing similar high-risk patients undergoing major surgeries.