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Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass.
Surg Obes Relat Dis. 2006 Jan-Feb; 2(1):11-6.SO

Abstract

OBJECTIVES

A precipitating factor for marginal ulcer formation after Roux-en-Y gastric bypass may be the prolonged irritation by foreign material, such as nonabsorbable suture at the gastrojejunostomy. This study examines the incidence of marginal ulcers before and after a change was made from using nonabsorbable suture to using absorbable suture for the inner layer of the anastomosis.

METHODS

A total of 3285 laparoscopic Roux-en-Y gastric bypass operations were performed during a 5-year period. The gastrojejunostomy technique was modified in August 2002. Those patients who developed a marginal ulcer postoperatively were identified, and their charts were retrospectively analyzed for the operative technique, patient age, history of previous gastric surgery, presence of preoperative diabetes, coronary artery disease, or peptic ulcer disease, and use of nonsteroidal anti-inflammatory medications or tobacco.

RESULTS

The incidence of marginal ulceration after Roux-en-Y gastric bypass decreased significantly from 2.6% (28/1095) with the use of nonabsorbable suture to 1.3% (29/2190) after the change to absorbable suture for the inner layer of the gastrojejunal anastomosis (P < .001). The incidence of visible suture adjacent to the ulcer on endoscopy was also significantly reduced (64.3% vs 3.4%; P < .001). When the results were corrected for length of follow-up, the difference in the incidence of ulcers occurring within 1 year of surgery remained significant between the two groups (P = .002). There were no other significant differences in the factors analyzed.

CONCLUSIONS

The use of nonabsorbable sutures for the inner layer of the gastrojejunal anastomosis is associated with an increased incidence of marginal ulcers, and the adoption of absorbable suture material has reduced this incidence.

Authors+Show Affiliations

Division of Minimally Invasive Surgery, Department of Surgery, University of Pittsburgh Medical Center, PA 15213, USA. sacksbc@upmc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16925306

Citation

Sacks, Bethany C., et al. "Incidence of Marginal Ulcers and the Use of Absorbable Anastomotic Sutures in Laparoscopic Roux-en-Y Gastric Bypass." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 2, no. 1, 2006, pp. 11-6.
Sacks BC, Mattar SG, Qureshi FG, et al. Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2(1):11-6.
Sacks, B. C., Mattar, S. G., Qureshi, F. G., Eid, G. M., Collins, J. L., Barinas-Mitchell, E. J., Schauer, P. R., & Ramanathan, R. C. (2006). Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 2(1), 11-6.
Sacks BC, et al. Incidence of Marginal Ulcers and the Use of Absorbable Anastomotic Sutures in Laparoscopic Roux-en-Y Gastric Bypass. Surg Obes Relat Dis. 2006 Jan-Feb;2(1):11-6. PubMed PMID: 16925306.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass. AU - Sacks,Bethany C, AU - Mattar,Samer G, AU - Qureshi,Faisal G, AU - Eid,George M, AU - Collins,Joy L, AU - Barinas-Mitchell,Emma J, AU - Schauer,Philip R, AU - Ramanathan,Ramesh C, PY - 2005/06/02/received PY - 2005/10/29/revised PY - 2005/10/31/accepted PY - 2006/8/24/pubmed PY - 2006/9/29/medline PY - 2006/8/24/entrez SP - 11 EP - 6 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 2 IS - 1 N2 - OBJECTIVES: A precipitating factor for marginal ulcer formation after Roux-en-Y gastric bypass may be the prolonged irritation by foreign material, such as nonabsorbable suture at the gastrojejunostomy. This study examines the incidence of marginal ulcers before and after a change was made from using nonabsorbable suture to using absorbable suture for the inner layer of the anastomosis. METHODS: A total of 3285 laparoscopic Roux-en-Y gastric bypass operations were performed during a 5-year period. The gastrojejunostomy technique was modified in August 2002. Those patients who developed a marginal ulcer postoperatively were identified, and their charts were retrospectively analyzed for the operative technique, patient age, history of previous gastric surgery, presence of preoperative diabetes, coronary artery disease, or peptic ulcer disease, and use of nonsteroidal anti-inflammatory medications or tobacco. RESULTS: The incidence of marginal ulceration after Roux-en-Y gastric bypass decreased significantly from 2.6% (28/1095) with the use of nonabsorbable suture to 1.3% (29/2190) after the change to absorbable suture for the inner layer of the gastrojejunal anastomosis (P < .001). The incidence of visible suture adjacent to the ulcer on endoscopy was also significantly reduced (64.3% vs 3.4%; P < .001). When the results were corrected for length of follow-up, the difference in the incidence of ulcers occurring within 1 year of surgery remained significant between the two groups (P = .002). There were no other significant differences in the factors analyzed. CONCLUSIONS: The use of nonabsorbable sutures for the inner layer of the gastrojejunal anastomosis is associated with an increased incidence of marginal ulcers, and the adoption of absorbable suture material has reduced this incidence. SN - 1550-7289 UR - https://www.unboundmedicine.com/medline/citation/16925306/Incidence_of_marginal_ulcers_and_the_use_of_absorbable_anastomotic_sutures_in_laparoscopic_Roux_en_Y_gastric_bypass_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(05)00897-X DB - PRIME DP - Unbound Medicine ER -