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Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center.
Surg Obes Relat Dis. 2014 Mar-Apr; 10(2):229-34.SO

Abstract

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.

Authors+Show Affiliations

Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health.Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health.Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health.Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health. Electronic address: muhammad.jawad@orlandohealth.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24462313

Citation

Moon, Rena C., et al. "Management and Treatment Outcomes of Marginal Ulcers After Roux-en-Y Gastric Bypass at a Single High Volume Bariatric Center." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 10, no. 2, 2014, pp. 229-34.
Moon RC, Teixeira AF, Goldbach M, et al. Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center. Surg Obes Relat Dis. 2014;10(2):229-34.
Moon, R. C., Teixeira, A. F., Goldbach, M., & Jawad, M. A. (2014). Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 10(2), 229-34. https://doi.org/10.1016/j.soard.2013.10.002
Moon RC, et al. Management and Treatment Outcomes of Marginal Ulcers After Roux-en-Y Gastric Bypass at a Single High Volume Bariatric Center. Surg Obes Relat Dis. 2014 Mar-Apr;10(2):229-34. PubMed PMID: 24462313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center. AU - Moon,Rena C, AU - Teixeira,Andre F, AU - Goldbach,Michael, AU - Jawad,Muhammad A, Y1 - 2013/10/11/ PY - 2013/07/16/received PY - 2013/09/16/revised PY - 2013/10/01/accepted PY - 2014/1/28/entrez PY - 2014/1/28/pubmed PY - 2014/12/15/medline KW - Complication KW - Gastric bypass KW - Marginal ulcer KW - Perforated ulcer SP - 229 EP - 34 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 10 IS - 2 N2 - 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. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/24462313/Management_and_treatment_outcomes_of_marginal_ulcers_after_Roux_en_Y_gastric_bypass_at_a_single_high_volume_bariatric_center_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(13)00326-2 DB - PRIME DP - Unbound Medicine ER -