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Varying marginal ulcer rates in patients undergoing laparoscopic Roux-en-Y gastric bypass for morbid obesity versus gastroesophageal reflux disease: is the acid pocket to blame?
Surg Obes Relat Dis. 2013 Nov-Dec; 9(6):862-6.SO

Abstract

BACKGROUND

Nissen fundoplication failure rates are increased in obese patients; however, conversion to laparoscopic Roux-en-Y gastric bypass (LRYGB) can resolve or improve gastroesophageal reflux disease (GERD) symptoms. Acid pockets near the gastroesophageal junction may influence these surgical outcomes. Our objective was to compare the outcomes for patients who underwent LRYGB for morbid obesity (MO) versus GERD.

METHODS

A retrospective review of our institution's bariatric database was completed. Statistical analysis included t test and χ(2) test.

RESULTS

LRYGBs were performed from 2001-2011 for MO and 2009-2010 for GERD. Eighty-three percent of patients in the GERD group had undergone previous antireflux surgery. The median time from initial presentation to LRYGB was significantly shorter in the GERD versus the MO group (105 days versus 241 days; P = .009). There was an increased rate of marginal ulcers in the GERD group compared with the MO group, at 50% versus 4.5%, respectively (P = .001). Stomal stenosis was also increased in the GERD group compared with the MO group, at 8.3% and .7%, respectively (P = .091). There were no in-hospital or 30-day mortalities.

CONCLUSION

Patients undergoing LRYGB for GERD had a shorter interval to surgery and an increased rate of marginal ulcers compared with those undergoing LRYGB for MO. Operative time was longest among patients in the GERD group. The acid pocket may explain the increased ulcer rate in the GERD population. Use of a smaller sized pouch may improve this outcome.

Authors+Show Affiliations

Minimally Invasive Bariatric and Advanced Laparoscopy Fellowship, Department of Medical Education, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23522621

Citation

Gilmore, Megan M., et al. "Varying Marginal Ulcer Rates in Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity Versus Gastroesophageal Reflux Disease: Is the Acid Pocket to Blame?" Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 9, no. 6, 2013, pp. 862-6.
Gilmore MM, Kallies KJ, Mathiason MA, et al. Varying marginal ulcer rates in patients undergoing laparoscopic Roux-en-Y gastric bypass for morbid obesity versus gastroesophageal reflux disease: is the acid pocket to blame? Surg Obes Relat Dis. 2013;9(6):862-6.
Gilmore, M. M., Kallies, K. J., Mathiason, M. A., & Kothari, S. N. (2013). Varying marginal ulcer rates in patients undergoing laparoscopic Roux-en-Y gastric bypass for morbid obesity versus gastroesophageal reflux disease: is the acid pocket to blame? Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 9(6), 862-6. https://doi.org/10.1016/j.soard.2013.01.017
Gilmore MM, et al. Varying Marginal Ulcer Rates in Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity Versus Gastroesophageal Reflux Disease: Is the Acid Pocket to Blame. Surg Obes Relat Dis. 2013 Nov-Dec;9(6):862-6. PubMed PMID: 23522621.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Varying marginal ulcer rates in patients undergoing laparoscopic Roux-en-Y gastric bypass for morbid obesity versus gastroesophageal reflux disease: is the acid pocket to blame? AU - Gilmore,Megan M, AU - Kallies,Kara J, AU - Mathiason,Michelle A, AU - Kothari,Shanu N, Y1 - 2013/02/06/ PY - 2012/08/30/received PY - 2013/01/09/revised PY - 2013/01/29/accepted PY - 2013/3/26/entrez PY - 2013/3/26/pubmed PY - 2014/9/5/medline KW - Acid pocket KW - Complications KW - Gastroesophageal reflux disease; KW - Laparoscopic Roux-en-Y gastric bypass; KW - Marginal ulcer KW - Nissen fundoplication SP - 862 EP - 6 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 9 IS - 6 N2 - BACKGROUND: Nissen fundoplication failure rates are increased in obese patients; however, conversion to laparoscopic Roux-en-Y gastric bypass (LRYGB) can resolve or improve gastroesophageal reflux disease (GERD) symptoms. Acid pockets near the gastroesophageal junction may influence these surgical outcomes. Our objective was to compare the outcomes for patients who underwent LRYGB for morbid obesity (MO) versus GERD. METHODS: A retrospective review of our institution's bariatric database was completed. Statistical analysis included t test and χ(2) test. RESULTS: LRYGBs were performed from 2001-2011 for MO and 2009-2010 for GERD. Eighty-three percent of patients in the GERD group had undergone previous antireflux surgery. The median time from initial presentation to LRYGB was significantly shorter in the GERD versus the MO group (105 days versus 241 days; P = .009). There was an increased rate of marginal ulcers in the GERD group compared with the MO group, at 50% versus 4.5%, respectively (P = .001). Stomal stenosis was also increased in the GERD group compared with the MO group, at 8.3% and .7%, respectively (P = .091). There were no in-hospital or 30-day mortalities. CONCLUSION: Patients undergoing LRYGB for GERD had a shorter interval to surgery and an increased rate of marginal ulcers compared with those undergoing LRYGB for MO. Operative time was longest among patients in the GERD group. The acid pocket may explain the increased ulcer rate in the GERD population. Use of a smaller sized pouch may improve this outcome. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/23522621/Varying_marginal_ulcer_rates_in_patients_undergoing_laparoscopic_Roux_en_Y_gastric_bypass_for_morbid_obesity_versus_gastroesophageal_reflux_disease:_is_the_acid_pocket_to_blame L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(13)00036-1 DB - PRIME DP - Unbound Medicine ER -