Mahawar K K, Reed A N, Graham Y N H
Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK.
Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.
Clin Obes. 2017 Jun;7(3):151-156. doi: 10.1111/cob.12186. Epub 2017 Mar 20.
Many surgeons believe that one anastomosis (mini) gastric bypass (OAGB/MGB) is associated with a high marginal ulcer (MU) rate and that this is associated with complications in a significant number of patients. The purpose of this survey was to find out the participant-reported incidence of MU after OAGB/MGB and its complications. We also aimed to understand practices in this cohort concerning prophylaxis, diagnosis, treatment and management of complications. Bariatric surgeons who perform OAGB/MGB procedures were invited to participate in a confidential, online survey using SurveyMonkey®. A total of 86 surgeons performing OAGB/MGB procedures participated in the survey. The total number of OAGB/MGB procedures reported was 27 672, revealing 622 MU, giving an MU rate of 2.24 %. Most participants (69/84, 82.4%) routinely use proton pump inhibitor (PPI) prophylaxis, but there was variation in drugs, dosages and duration. The majority (49/85, 57.6%) of participants 'always' use endoscopy for diagnosis, and 48.1% (39/81) 'always' perform an endoscopy to ensure healing. Most (49/55) perforated ulcers were treated with laparoscopic repair +/- omentoplasty +/- drainage. Most (55/59, 93.0%) of the bleeding ulcers were managed with PPI +/- blood transfusions +/- endoscopic intervention (23/59, 39.0%). Non-healing ulcers were treated by conversion to Roux-en-Y gastric bypass (RYGB) in 46.5% of patients (n = 20/43). The participants did not report any MU-related mortality but described a number of risk factors for it. This survey is the first detailed attempt to understand the incidence of MU following OAGB/MGB; its complications; and practices concerning prophylaxis, diagnosis, treatment and management of complications.
许多外科医生认为，单吻合口（迷你）胃旁路术（OAGB/MGB）与较高的吻合口溃疡（MU）发生率相关，且这与相当数量患者的并发症有关。本调查的目的是了解参与者报告的OAGB/MGB术后MU发生率及其并发症情况。我们还旨在了解该队列中关于并发症预防、诊断、治疗及管理的做法。邀请实施OAGB/MGB手术的减重外科医生参与一项使用SurveyMonkey®进行的保密在线调查。共有86名实施OAGB/MGB手术的外科医生参与了调查。报告的OAGB/MGB手术总数为27672例，其中有622例发生MU，MU发生率为2.24%。大多数参与者（69/84，82.4%）常规使用质子泵抑制剂（PPI）进行预防，但在药物、剂量和疗程方面存在差异。大多数参与者（49/85，57.6%）“总是”使用内镜进行诊断，48.1%（39/81）“总是”进行内镜检查以确保愈合。大多数（49/55）穿孔性溃疡采用腹腔镜修补术+/-网膜成形术+/-引流术治疗。大多数（55/59，93.0%）出血性溃疡采用PPI+/-输血+/-内镜干预（23/59，39.0%）进行处理。46.5%（n=20/43）的患者因溃疡不愈合而改行Roux-en-Y胃旁路术（RYGB）治疗。参与者未报告任何与MU相关的死亡病例，但描述了一些相关危险因素。本次调查是首次详细尝试了解OAGB/MGB术后MU的发生率、其并发症以及并发症预防、诊断、治疗及管理的做法。
