Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center.

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.