Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery · 2013
Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center.
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Moon Rena C, Teixeira Andre F, Goldbach Michael, Jawad Muhammad A
Аннотация
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.
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.