Pontecorvo Agustina A, Cornejo Jorge, Tsenteradze Tamar, Veenstra Benjamin, Bowers Steven, Elli Enrique F
Division of Advanced Gastrointestinal and Bariatric Surgery, Department of General Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
Surg Endosc. 2025 Sep 2. doi: 10.1007/s00464-025-12130-4.
Marginal ulcer (MU) is a rare complication following Roux-en-Y Gastric Bypass (RYGB). If left untreated, MU can progress into severe sequelae, including ulcer stenosis, gastrogastric fistula (GGF), or perforation. The aim of this study is to describe the surgical management for each of the three types of MU sequelae and to evaluate the risk of ulcer recurrence and the impact on weight loss following Revisional Bariatric Surgery (RBS).
A retrospective analysis of patients who underwent RBS for MU sequelae between October 2008 and October 2024 was conducted. Patients' demographics, perioperative outcomes, weight loss, and ulcer recurrence were compared between the three types of MU sequelae.
Sixty-six patients were included. Thirty-nine percent had ulcer stenosis, 30.3% had GGF, and 30.3% had perforation. The mean time in years from RYGB to the RBS was 6.9 years for patients with stenosis, 17.5 years for those with GGF, and 5.3 years for those with perforation. Epigastric pain, nausea, and vomiting were common, and PO intolerance was mainly seen in ulcer stenosis. Operative time varied significantly, with the GGF group having the longest duration (p = 0.001). This group also showed higher rates of Clavien-Dindo grade ≥ 3 complications and reinterventions (p = 0.01). Five-year follow-up showed that patients with GGF had the greatest percentage of total weight loss (p = 0.007), while patients with ulcer stenosis experienced weight regain during the first two years and slight weight regain at the later follow-up. The overall ulcer recurrence was 32.4%, with no significant differences observed in recurrence rates among them (p = 0.98).
Managing MU after RYGB requires comprehensive diagnosis, including upper GI endoscopy, swallow study, and abdominal CT, to assess anatomical abnormalities. While surgery is effective, the recurrence of ulcers remains a risk. Patients with stenosis often regain weight after redo gastrojejunostomy, whereas those with GGF tended to lose weight after RBS.
边缘性溃疡（MU）是Roux-en-Y胃旁路术（RYGB）后一种罕见的并发症。如果不进行治疗，MU可能会发展为严重的后遗症，包括溃疡狭窄、胃胃瘘（GGF）或穿孔。本研究的目的是描述三种类型的MU后遗症的手术治疗方法，并评估肥胖症修正手术（RBS）后溃疡复发的风险以及对体重减轻的影响。
对2008年10月至2024年10月期间因MU后遗症接受RBS的患者进行回顾性分析。比较了三种类型的MU后遗症患者的人口统计学特征、围手术期结果、体重减轻情况和溃疡复发情况。
纳入66例患者。39%有溃疡狭窄，30.3%有GGF，30.3%有穿孔。从RYGB到RBS的平均时间，狭窄患者为6.9年，GGF患者为17.5年，穿孔患者为5.3年。上腹部疼痛、恶心和呕吐很常见，口服不耐受主要见于溃疡狭窄患者。手术时间差异显著，GGF组持续时间最长（p = 0.001）。该组还显示Clavien-Dindo≥3级并发症和再次干预的发生率更高（p = 0.01）。五年随访显示，GGF患者的总体重减轻百分比最大（p = 0.007），而溃疡狭窄患者在头两年体重增加，后期随访时略有体重增加。总体溃疡复发率为32.4%，三者之间的复发率无显著差异（p = 0.98）。
RYGB术后处理MU需要进行全面诊断，包括上消化道内镜检查、吞咽研究和腹部CT，以评估解剖学异常。虽然手术有效，但溃疡复发仍然是一个风险。狭窄患者在再次行胃空肠吻合术后常体重增加，而GGF患者在RBS后往往体重减轻。
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