Prevalence of early marginal ulcer in sleeve to bypass conversions: an analysis of the 2020-2022 MBSAQIP.

BACKGROUND

Early marginal ulceration (MU) within 30 days after operation is uncommon after Roux-en-Y gastric bypass (RYGB), yet recent evidence indicates that these rates may be higher than initially thought. We hypothesized that the incidence of early MU would be higher in patients undergoing sleeve gastrectomy-RYGB (SG-RYGB) conversion compared with primary RYGB (p-RYGB).

SETTING

National quality improvement data from Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited sites in the United States, 2020-2022.

METHODS

Examination of 610,529 records from the 2020-2022 MBSAQIP data sets noted 136,392 RYGB cases, after exclusions for pediatric cases, nonbinary gender, and records missing body mass index (BMI), operative time, age, and non-SG-RYGB conversions. We compared SG-RYGB and p-RYGB patient characteristics, surgical details, and postoperative outcomes, using rare event logistic regression to model early MU risk based on sleeve conversion status and additional risk factors.

RESULTS

Early MU developed in .2% (337 of 136,392) of p-RYGB cases and .4% (109 of 26,333) of SG-RYGB cases (P < .0001). SG-RYGB conversion was a significant predictor of early MU in a multivariable model (odds ratio: 1.42, 95% confidence interval: 1.10-1.84, P = .0069), along with factors such as Black race, BMI <30, chronic obstructive pulmonary disease, prior cardiac catheterization, history of deep vein thrombosis, and active immunosuppression.

CONCLUSIONS

Early MU remains a rare event after RYGB. Patients undergoing SG-RYGB face a 42% greater risk of developing early MU compared with those receiving p-RYGB, indicating the necessity for enhanced MU prevention measures in this demographic.