Marginal ulceration following Roux-en-Y gastric bypass: risk factors for ulcer development, recurrence and need for revisional surgery

Palma, Adam Di; Liu, Benjamin D.; Maeda, Azusa; Anvari, Mehran; Jackson, Timothy; Okrainec, Allan

doi:10.1007/s00464-020-07650-0

Cited by 49 publications

(33 citation statements)

References 23 publications

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“…Patients with a history of smoking, immunosuppression and preoperative non-steroidal anti-inflammatory drugs use were significantly more likely to develop a MU requiring surgical revision. Patients undergoing revision had a resolution of their symptoms in only 36% of the cases, while 57% developed a recurrent ulcer [ 123 ].…”

Section: Resultsmentioning

confidence: 99%

Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

et al. 2022

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Background Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Method A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Conclusions The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.

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Section: Resultsmentioning

confidence: 99%

Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

et al. 2022

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“…The rate of marginal ulcers varies from 7%-34%. [25][26][27] In our center, we found 16.7% of the RYGB patients had marginal ulcers at the routine postoperative endoscopy. Most of the patients were asymptomatic, so no early endoscopy had been performed before 1 year after surgery.…”

Section: Discussionmentioning

confidence: 81%

Surgical Outcomes of Bariatric Surgery in Siriraj Hospital for the First 100 Morbidly Obese Patients Treated

et al. 2022

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Objective: Bariatric surgery is considered the most effective treatment for morbid obesity, and is increasingly performed in Thailand and globally. We aimed to establish the outcomes of bariatric surgery performed at Siriraj Hospital, Bangkok. Materials and Methods: This was a retrospective study of patients who underwent bariatric surgery between January 2012 and June 2016. Results: The records of the first 100 patients who underwent bariatric surgery were reviewed, comprising 58 patients who underwent laparoscopic sleeve gastrectomy (LSG) and 42 patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). The median patient age, preoperative body weight, and BMI were 36 years old, 129 kg, and 46.3 kg/m2. All the procedures were performed by a laparoscopic approach. The median operative times for LSG and LRYGB were 156 [85-435] and 265 [180-435] minutes. The median hospital stay was 3 days [3-14]. The major complication rate was 4%. There was no mortality in the 30-day postoperative period. The mean %excess weight loss (%EWL) of LSG was 56.8 ± 19.8%, 59.9 ± 21.7%, and 55.1 ± 21.3%, at 1, 2, and 3 years after surgery. The mean %EWL of LRYGB was 67 ± 18.3%, 66.2 ± 21.4%, and 63.6 ± 19.9%, at 1, 2, and 3 years after surgery. In the patients with type-II diabetes mellitus, 67% had complete diabetic remission at 1 year. The median FBS dropped from 127 to 99 mg/dL (p < 0.001) and HbA1c from 6.6% to 5.5% (p < 0.001). The remission rates of hypertension and dyslipidemia were 58% and 73%. Conclusion: The bariatric procedures are safe with a low complication rate. The procedures also provide good outcomes in postoperative weight loss and comorbidity resolution.

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“…Marginal ulcers (MU) are a well-documented complication following RYGB, with a reported incidence of around 6.5%. However, depending on the specific definition used, rates range from 0.6%-16% [4,[62][63][64] . Risk factors include non-steroidal anti-inflammatory drug use, Helicobacter pylori infection, tobacco use, alcohol use, steroid use, large gastric pouch, gastrogastric fistula (GGF), and obstructing sleep apnea [65] .…”

Section: Marginal Ulcerationmentioning

confidence: 99%

Revisional bariatric surgery: a review of workup and management of common complications after bariatric surgery

Lyons¹,

Omar²,

Tholey³

et al. 2022

MIS

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With the rising prevalence of obesity, there has been a steady rise in the number of bariatric surgeries performed worldwide. As expected, there has also been an increase in the number of revisional surgeries performed to manage acute and chronic postoperative complications. This review will discuss the major complications that can arise from the most common bariatric surgeries, their diagnosis, medical management, and potential revisional surgical options.

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Marginal ulceration following Roux-en-Y gastric bypass: risk factors for ulcer development, recurrence and need for revisional surgery

Cited by 49 publications

References 23 publications

Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

Surgical Outcomes of Bariatric Surgery in Siriraj Hospital for the First 100 Morbidly Obese Patients Treated

Revisional bariatric surgery: a review of workup and management of common complications after bariatric surgery

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