Marginal ulcer after Roux-en-Y gastric bypass: what have we really learned?

El‐Hayek, Kevin; Timratana, Poochong; Shimizu, Hiroki; Chand, Bipan

doi:10.1007/s00464-012-2280-x

Cited by 96 publications

(46 citation statements)

References 27 publications

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“…This will affect the detection of MU. Several studies suggest MU is fairly frequent in the early postoperative period [25,26]. Only 24% of MU in the present study occurred early.…”

Section: Discussioncontrasting

confidence: 70%

Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass

Lee¹,

McBride²,

Shostrom³

et al. 2013

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Background: Marginal ulceration (MU) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. While several possible risk factors have been reported, the mechanism of MU remains incompletely understood. The aim of this study was to compare the effect of surgical technique on the incidence of MU. Methods and Material: This was a retrospective study of 749 patients undergoing RYGB over a ten-year period with at least one year of follow-up. The diagnosis of MU was made based on clinical symptoms and confirmed by postoperative endoscopy (POE). We assessed four different gastric bypass (GBP) techniques: T1-Open, non-divided stomach, circular stapler, non-vagotomy (n = 332); T2-Open, divided stomach, circular stapler, vagotomy (n = 91); T3-Laparoscopic, divided, circular stapler, vagotomy (n = 152); T4-Laparoscopic, divided, linear stapler, vagotomy (n = 174). Results: The four groups were similar with respect to age and mean BMI. The frequency of POE was 16%, 25%, 28% and 27% in groups T1-T4 respectively (NS). The incidence of MU was significantly lower in T1 (2.1%) compared to T2 (5.5%), T3 (15.1%) and T4 (12.6%), p < 0.05. MU occurred significantly more frequently with an antecolic Roux limb versus retrocolic (14.5% vs 5.6%, p < 0.05). Conclusion: The incidence of MU after RYGB surgery is influenced by surgical technique. The lowest incidence of MU was with a non-divided stomach, no vagotomy, transverse staple line, and circular stapled anastomosis. A retrocolic Roux limb was protective. There was no difference in the incidence of MU using laparoscopic versus open bypass if a similar technique was employed or using linear versus circular stapler for the gastrojejunostomy.

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“…This will affect the detection of MU. Several studies suggest MU is fairly frequent in the early postoperative period [25,26]. Only 24% of MU in the present study occurred early.…”

Section: Discussioncontrasting

confidence: 70%

Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass

Lee¹,

McBride²,

Shostrom³

et al. 2013

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“…Si bien la mayoría de los estudios muestran cifras de prevalencia menores al 10% [8][9][10][11][12][13][14] , existen informes que hablan de hasta un 34% en pacientes sintomáticos 15 , cifra que también variaría dependiendo del momento en que se realice la endoscopia, ya que el riesgo sería mayor en el período postoperatorio temprano que en el seguimiento a largo plazo 11,16 . Debido a esto, se han estudiado diferentes factores que inciden en el desarrollo de esta patología, nombrándose múltiples condiciones que se asocian a esta complicación.…”

Section: Discussionunclassified

“…El tabaquismo y el uso de AInES han sido descritos como factores de riesgo en varias series 9,15,17 , así como también la existencia de Helicobacter pylori, y la presencia de un mayor número de células parietales; ya sea por una bolsa gástrica de mayor tamaño o por la existencia de una fístula gastrogástrica 9,13,15 . La realización de la gastro-yeyuno anastomosis con material de sutura no reabsorbible; manteniendo cierto gado de inflamación local persistente 9 , la isquemia de la anastomosis, secundaria a una mayor tensión al realizar una anastomosis ante-cólica o secundario al uso excesivo de suturas mecánicas al confeccionar la bolsa 18 o por ser el paciente en sí portador de factores de riesgo para insuficiencia vascular (diabetes, enfermedad arterial, etc.…”

Section: Discussionunclassified

“…la erradicación de Helicobacter pylori y el uso de inhibidores de la bomba de protones, con lo cual la gran mayoría presenta regresión completa de las lesiones 11,13 y sólo en casos muy específicos se plantea la cirugía, como cuando se pesquisa algún factor de riesgo corregible por esta vía (por ejemplo una fístula gastro-gástrica) o en el caso de úlceras marginales refractarias, en las cuales se pueden plantear otras opciones como la resección y re-confección de la anastomosis 7,15,20 . Hay que tener en cuenta que un pequeño porcentaje puede presentar recurrencia de la úlcera marginal una vez tratada, presentando una mayor probabilidad de sangrado o perforación y, por lo tanto, la necesidad de tratamiento quirúrgico 9 .…”

Section: Figuraunclassified

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Úlcera Marginal Perforada Post Bypass Gástrico Laparoscópico

et al. 2015

Rev Chil Cir

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Perforated marginal ulcer after laparoscopic gastric bypass introduction: Perforated marginal ulcer is a serious event that usually requires reoperation and is associated with morbidity and mortality. Characterization and management of these patients is still debated. Objective: To describe a series of patients subjected to a laparoscopic gastric bypass (LGBP) that evolved with a perforated marginal ulcer. material and methods: Records of patients undergoing a LGBP the last 10 years and evolved with a perforated marginal ulcer were retrospectively reviewed. Clinical features, treatment and perioperative morbidity and mortality were analyzed. results: During this period 2,095 patients were subjected to a LGBP, 12 of them presented a perforated marginal ulcer, corresponding to 10 women and 2 men. Mean age was 39 (21-60) and mean body mass index at the time of initial surgery was 34 (29.3 to 38.6). Ten patients were smoker at the moment of perforation. The occurrence of this happened at a mean of 27 months (range 3-54, median 23.5) after surgery. Eleven cases had a surgical resolution, with a laparoscopic approach in 9 of them and laparotomy on 2. In all cases, a perforated ulcer in the jejunal side of the gastrojejunal anastomosis was found. There was no mortality or morbidity associated with surgery. conclusions: In our experience the occurrence of perforated marginal ulcer after a LGBP develops in a small percentage of patients. The laparoscopic approach is of choice, presenting a low morbidity and mortality. Smoking was present in most patients.

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“…However, a recent study has shown significantly higher marginal ulceration rates (34%) in 328 symptomatic patients who underwent endoscopic exploration after RYGB. Uni-and multi-variate analyses for associated risk factors identified tobacco as the most significant risk factor for marginal ulceration recurrence (33).…”

Section: Complications Of Metabolic Surgerymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Metabolic effects of bariatric surgery

Corcelles

Daigle

Schauer

2016

European Journal of Endocrinology

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Obesity is associated with an increased risk of type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, osteoarthritis, numerous cancers and increased mortality. It is estimated that at least 2.8 million adults die each year due to obesity-related cardiovascular disease. Increasing in parallel with the global obesity problem is metabolic syndrome, which has also reached epidemic levels. Numerous studies have demonstrated that bariatric surgery is associated with significant and durable weight loss with associated improvement of obesity-related comorbidities. This review aims to summarize the effects of bariatric surgery on the components of metabolic syndrome (hyperglycemia, hyperlipidemia and hypertension), weight loss, perioperative morbidity and mortality, and the long-term impact on cardiovascular risk and mortality.

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Marginal ulcer after Roux-en-Y gastric bypass: what have we really learned?

Cited by 96 publications

References 27 publications

Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass

Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass

Úlcera Marginal Perforada Post Bypass Gástrico Laparoscópico

MANAGEMENT OF ENDOCRINE DISEASE: Metabolic effects of bariatric surgery

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