Ophélie Bacoeur-Ouzillou1,2,3, Julie Perinel4,5, Elise Pelascini4, Mourad Abdallah6,7, Gilles Poncet4,5, Arnaud Pasquer4,5, Maud Robert8,9,10. 1. Chirurgie viscérale et digestive, CHU Clermont-Ferrand, Hôpital Estaing, 1 Place Lucie et Raymond Aubrac, 63000, Clermont Ferrand, France. obacoeurouzillou1@chu-clermontferrand.fr. 2. Faculté de Médecine, Université Clermont Auvergne, 28 Place Henri Dunant, 63001, Clermont Ferrand, France. obacoeurouzillou1@chu-clermontferrand.fr. 3. Chirurgie viscérale et Bariatrique, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437, Lyon, France. obacoeurouzillou1@chu-clermontferrand.fr. 4. Chirurgie viscérale et Bariatrique, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437, Lyon, France. 5. Université Lyon 1, 8 Avenue Rockefeller, 69373, Lyon Cedex 08, France. 6. Chirurgie viscérale et digestive, CHU Clermont-Ferrand, Hôpital Estaing, 1 Place Lucie et Raymond Aubrac, 63000, Clermont Ferrand, France. 7. Faculté de Médecine, Université Clermont Auvergne, 28 Place Henri Dunant, 63001, Clermont Ferrand, France. 8. Chirurgie viscérale et Bariatrique, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437, Lyon, France. maud.robert@chu-lyon.fr. 9. Université Lyon 1, 8 Avenue Rockefeller, 69373, Lyon Cedex 08, France. maud.robert@chu-lyon.fr. 10. CarMeN Lab, INSERM Unit 1060, Hôpital LYON SUD Secteur 2 Bâtiment Cens-Eli D 165 Chemin du Grand Revoyet, 69310, Pierre Bénite, France. maud.robert@chu-lyon.fr.
Abstract
BACKGROUND: Marginal ulcers (MU) after gastric bypass are a challenging problem. The first-line treatment is a medical therapy with eviction of risk factors but is sometimes insufficient. The management strategies of intractable ulcers are still not clearly defined. The aim of our study was to analyse the risk factors for recurrence, the management strategies used and their efficiencies. METHODS: Based on a retrospective analysis of all MU managed in our tertiary care centre of bariatric surgery during the last 14 years, a descriptive analysis of the cohort, the management strategies and their efficiency were analysed. A logistic regression was done to identify the independent associated risk factors of intractable ulcer. RESULTS: Fifty-six patients matched inclusion criteria: 30 were referred to us (13 Roux-en-Y Gastric Bypass-RYGB and 17 One Anastomosis Gastric Bypass-OAGB), 26 were operated on in our institution (24 RYGB and 2 OAGB). 11 patients had a complicated inaugural MU requiring an interventional procedure in emergency: 7 perforations, 4 haemorrhages. The majority of MU were treated medically as a first-line therapy (n = 45; 80.4%). 32 MU recurred: 20 patients required surgery as a 2nd line therapy, 6 were operated on as a 3rd line therapy and 1 had a surgery as a 5th line therapy. The OAGB was the only risk factor of recurrence (p = 0.018). We found that the Surgical management was significantly more frequent for patients with a OAGB (84% versus 35% for RYGB, p = 0.001); the most performed surgical procedure was a conversion of OAGB to RYGB (n = 11, 37.9%). CONCLUSION: Surgery was required for a large number of MU especially in case of recurrence, but recurrence can still occur after the surgery. The OAGB was the only risk factor of recurrence identified and conversion to RYGB seemed to be effective for the healing.
BACKGROUND: Marginal ulcers (MU) after gastric bypass are a challenging problem. The first-line treatment is a medical therapy with eviction of risk factors but is sometimes insufficient. The management strategies of intractable ulcers are still not clearly defined. The aim of our study was to analyse the risk factors for recurrence, the management strategies used and their efficiencies. METHODS: Based on a retrospective analysis of all MU managed in our tertiary care centre of bariatric surgery during the last 14 years, a descriptive analysis of the cohort, the management strategies and their efficiency were analysed. A logistic regression was done to identify the independent associated risk factors of intractable ulcer. RESULTS: Fifty-six patients matched inclusion criteria: 30 were referred to us (13 Roux-en-Y Gastric Bypass-RYGB and 17 One Anastomosis Gastric Bypass-OAGB), 26 were operated on in our institution (24 RYGB and 2 OAGB). 11 patients had a complicated inaugural MU requiring an interventional procedure in emergency: 7 perforations, 4 haemorrhages. The majority of MU were treated medically as a first-line therapy (n = 45; 80.4%). 32 MU recurred: 20 patients required surgery as a 2nd line therapy, 6 were operated on as a 3rd line therapy and 1 had a surgery as a 5th line therapy. The OAGB was the only risk factor of recurrence (p = 0.018). We found that the Surgical management was significantly more frequent for patients with a OAGB (84% versus 35% for RYGB, p = 0.001); the most performed surgical procedure was a conversion of OAGB to RYGB (n = 11, 37.9%). CONCLUSION: Surgery was required for a large number of MU especially in case of recurrence, but recurrence can still occur after the surgery. The OAGB was the only risk factor of recurrence identified and conversion to RYGB seemed to be effective for the healing.