Surgical management and outcomes of patients with marginal ulcer after Roux-en-Y gastric bypass

Chau, Edward; Youn, Heekoung; Ren-Fielding, Christine; Fielding, George; Schwack, Bradley; Kurian, Marina

doi:10.1016/j.soard.2014.12.011

Cited by 28 publications

(11 citation statements)

References 24 publications

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“…Addressing refractory marginal ulceration through surgery involves interventions such as vagotomy and revisional procedures, including gastrectomy and revision of the gastrojejunal anastomosis (GJA). These surgical approaches are associated with heightened risks of complications such as leaks, bleeding, sepsis, conversion from laparoscopic to open procedures, and postoperative chronic pain [83][84][85] . The elevated risk profile is particularly notable in individuals with a history of prior open operations who are now undergoing revisions.…”

Section: Surgical Treatmentsmentioning

confidence: 99%

Marginal ulceration after Roux-en-Y gastric bypass - literature review and management algorithm

Baldwin,

Ali,

Altieri

et al. 2024

Metab Target Organ Damage

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Roux-en-Y gastric bypass (RYGB)-associated marginal ulceration (MU) poses significant challenges for both patients and clinicians. Persistent symptoms such as epigastric pain, nausea, and reduced oral intake complicate the clinical landscape. MU can lead to severe complications, including anastomotic strictures, bleeding, and perforations. The etiology of MU is intricate, likely stemming from a combination of technical and patient-related factors. Technical considerations involve ischemia, tension on the anastomosis causing tissue ischemia, anastomotic technique, gastric pouch size, foreign bodies, and gastrogastric fistulas. Patient factors encompass smoking, nonsteroidal anti-inflammatory drugs (NSAIDs), Helicobacter pylori (H. pylori), and uncontrolled medical comorbidities. Diagnosis primarily relies on upper endoscopy. Initial treatment typically involves proton pump inhibitors (PPI) and sucralfate. Should these measures prove insufficient, the addition of misoprostol and the implementation of endoscopic techniques, such as oversewing or stenting across the ulcer, may be considered to facilitate healing. Ultimately, if medical and endoscopic interventions fail, surgical options become imperative. These include transthoracic truncal vagotomy and revisional procedures such as resection of the ulcer with redo gastrojejunal anastomosis, resection of the ulcer and pouch with esophagojejunal anastomosis, or resection and reversal to normal anatomy. Surgical interventions demand expertise and should be conducted at qualified, high-volume centers. To support clinicians in comprehending the nuances of MU, we conducted a literature review, presenting a summary of our findings. Additionally, we propose an algorithm delineating the escalation of treatments for MU, ranging from medical to endoscopic to surgical therapies. This concise review aims to assist clinicians in both the prevention and treatment of marginal ulceration.

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Section: Surgical Treatmentsmentioning

confidence: 99%

Marginal ulceration after Roux-en-Y gastric bypass - literature review and management algorithm

Baldwin,

Ali,

Altieri

et al. 2024

Metab Target Organ Damage

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“…Candidates for revision of the gastro-jejunostomy alone must not have an additional fistula, such as a gastro-gastric fistula. For roughly one-third of patients, gastro-jejunostomy revision may cure their marginal ulcer disease [61,73,74] . In the absence of a concomitant gastro-gastric fistula, revision can generally be accomplished by revision of the gastro-jejunostomy alone.…”

Section: Operations For Marginal Ulceration and Stricture Of The Gast...mentioning

confidence: 99%

Revisional bariatric surgery for chronic complications necessitates custom surgical solutions

Strong¹,

Guerrón²

2022

Mini-invasive Surg

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Bariatric surgery continues to grow as a treatment modality for obesity and weight-related comorbidities. The anatomic rearrangement can produce unique anatomic complications, as well as functional problems that are correctible with revisional operations. Understanding the unique subset of complications and the options available for correction can allow surgical solutions to be tailored to both the patient’s anatomy, and the symptoms or pathologies they are targeting. Revisional operations are becoming increasingly common, as the proportion of the general population who have previously undergone bariatric surgery continues to increase. Revisional bariatric operations are associated with an increased risk of complications and longer hospital stays, but in experienced centers can be performed safely, and often using minimally invasive approaches.

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“…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] . Symptoms of MU are similar to those of peptic ulcer disease and include epigastric pain, pyrosis, and nausea.…”

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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Surgical management and outcomes of patients with marginal ulcer after Roux-en-Y gastric bypass

Cited by 28 publications

References 24 publications

Marginal ulceration after Roux-en-Y gastric bypass - literature review and management algorithm

Marginal ulceration after Roux-en-Y gastric bypass - literature review and management algorithm

Revisional bariatric surgery for chronic complications necessitates custom surgical solutions

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

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