Rena C Moon1, Andre F Teixeira1, Michael Goldbach1, Muhammad A Jawad2. 1. Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health. 2. Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health. Electronic address: muhammad.jawad@orlandohealth.com.
Abstract
BACKGROUND: Marginal ulceration (MU) is one of the most common complications after Roux-en-Y gastric bypass (RYGB). However, the rate of MU varies from 1% to 16% of RYGB patients and predisposing factors remain unclear. The aim of this study is to describe frequency, management, and outcomes of treatment in patients with MU after laparoscopic RYGB. METHODS: Between January 2004 and December 2012, a total of 2,535 patients underwent laparoscopic RYGB at our institution. Patients were routinely placed on proton pump inhibitors (PPI) for 90 days after the procedure. A total of 59 (2.3%) patients presented with MU. A retrospective review of a prospectively collected database was performed for all patients. RESULTS: Patients with MU presented with abdominal pain (n = 35), nausea/vomiting (n = 9), anemia (n = 5), hematemesis (n = 5), and dysphagia (n = 5) as chief complaints. Diagnosis was made at a mean period of 15.2 ± 17.4 months (range, 1-64) after the laparoscopic RYGB. Of these patients, 26 (44.1%) required reoperations including 12 (20.3%) with perforated ulcers. Urgent operation was required in 14 (23.7%) patients due to perforation or active bleeding, and elective operation was performed in 10 (16.9%) patients for chronic and refractory MU or gastrogastric fistula. One (1.7%) patient developed recurrent MU after the revision and had another revision of the anastomosis. One (1.7%) patient underwent reversal of gastric bypass after the revision due to malnutrition and recurrent ulcers. All patients did well at a mean follow up of 28.9 ± 21.7 months (range, 1-78 mo). CONCLUSION: Despite the use of routine PPI, the incidence of MU was not insignificant. A significant portion of patients required surgical treatment. Perforations can be effectively managed by oversewing of the ulcer.
BACKGROUND: Marginal ulceration (MU) is one of the most common complications after Roux-en-Y gastric bypass (RYGB). However, the rate of MU varies from 1% to 16% of RYGB patients and predisposing factors remain unclear. The aim of this study is to describe frequency, management, and outcomes of treatment in patients with MU after laparoscopic RYGB. METHODS: Between January 2004 and December 2012, a total of 2,535 patients underwent laparoscopic RYGB at our institution. Patients were routinely placed on proton pump inhibitors (PPI) for 90 days after the procedure. A total of 59 (2.3%) patients presented with MU. A retrospective review of a prospectively collected database was performed for all patients. RESULTS:Patients with MU presented with abdominal pain (n = 35), nausea/vomiting (n = 9), anemia (n = 5), hematemesis (n = 5), and dysphagia (n = 5) as chief complaints. Diagnosis was made at a mean period of 15.2 ± 17.4 months (range, 1-64) after the laparoscopic RYGB. Of these patients, 26 (44.1%) required reoperations including 12 (20.3%) with perforated ulcers. Urgent operation was required in 14 (23.7%) patients due to perforation or active bleeding, and elective operation was performed in 10 (16.9%) patients for chronic and refractory MU or gastrogastric fistula. One (1.7%) patient developed recurrent MU after the revision and had another revision of the anastomosis. One (1.7%) patient underwent reversal of gastric bypass after the revision due to malnutrition and recurrent ulcers. All patients did well at a mean follow up of 28.9 ± 21.7 months (range, 1-78 mo). CONCLUSION: Despite the use of routine PPI, the incidence of MU was not insignificant. A significant portion of patients required surgical treatment. Perforations can be effectively managed by oversewing of the ulcer.
Authors: Seth J Concors; Brett L Ecker; Richard Maduka; Alyssa Furukawa; Steven E Raper; Daniel D Dempsey; Noel N Williams; Kristoffel R Dumon Journal: Curr Treat Options Neurol Date: 2016-01 Impact factor: 3.598