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Published on: March 20, 2017
Perforated marginal ulcers after laparoscopic gastric bypass
Edward L Felix1, John Kettelle, Elijah Mobley
1UCSF Fresno Department of Surgery, Clovis Hospital, Fresno, CA 93710, USA. elfelixmd@aol.com
Background:
Perforated marginal ulcer (PMU) after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a serious complication, but its incidence and etiology have rarely been investigated. Therefore, a retrospective review of all patients undergoing LRYGB at the authors' center was conducted to determine the incidence of PMU and whether any causative factors were present.
Methods:
A prospectively kept database of all patients at the authors' bariatric center was retrospectively reviewed. The complete records of patients with a PMU were examined individually for accuracy and analyzed for treatment, outcome, and possible underlying causes of the marginal perforation.
Results:
Between April 1999 and August 2007, 1% of the patients (35/3,430) undergoing laparoscopic gastric bypass experienced one or more perforated marginal ulcers 3 to 70 months (median, 18 months) after LRYGB. The patients with and without perforation were not significantly different in terms of mean age (37 vs 41 years), weight (286 vs 287 lb), body mass index (BMI) (46 vs 47), or female gender (89% vs 83%). Of the patients with perforations, 2 (6%) were taking steroids, 10 (29%) were receiving nonsteroidal antiinflammatory drugs (NSAIDs) at the time of the perforation, 18 (51%) were actively smoking, and 6 of the smokers also were taking NSAIDs. Eleven of the patients (31%) who perforated did not have at least one of these possible risk factors, but 4 (36%) of the 11 patients in this group had been treated after bypass for a marginal ulcer. Only 7 (20%) of the 35 patients who had laparoscopic bypass, or 7 (0.2%) in the entire group of 3,430 patients, perforated without any warning. There were no deaths, but three patients reperforated.
Conclusions:
The incidence of a marginal ulcer perforating after LRYGB was significant (>1%) and appeared to be related to smoking or the use of NSAIDs or steroids. Because only 0.2% of all patients acutely perforated without some risk factor or warning, long-term ulcer prophylaxis or treatment may be necessary for only a select group of high-risk patients.
Insights
Perforated marginal ulcers (PMU) occur in over 1% of patients after laparoscopic Roux-en-Y gastric bypass (LRYGB). Smoking, NSAIDs, and steroid use are identified risk factors for PMU.
Area of Science:
- Bariatric Surgery
- Gastroenterology
- Surgical Complications
Background:
- Perforated marginal ulcer (PMU) is a serious complication following laparoscopic Roux-en-Y gastric bypass (LRYGB).
- The incidence and etiology of PMU after LRYGB have been infrequently studied.
- This study aimed to determine the incidence of PMU and associated risk factors in LRYGB patients.
Purpose of the Study:
- To determine the incidence of perforated marginal ulcers (PMU) after laparoscopic Roux-en-Y gastric bypass (LRYGB).
- To investigate potential causative factors associated with PMU in this patient population.
Main Methods:
- Retrospective review of a prospectively maintained database of all patients undergoing LRYGB.
- Individual analysis of patient records with PMU to assess treatment, outcomes, and potential underlying causes.
- Comparison of demographic data between patients with and without perforation.
Main Results:
- The incidence of PMU was 1% (35/3,430 patients) between April 1999 and August 2007.
- Patients with PMU showed no significant differences in age, weight, BMI, or gender compared to controls.
- Risk factors identified included active smoking (51%), NSAID use (29%), and steroid use (6%); 36% of those without these factors had a history of marginal ulcer treatment.
- Only 0.2% of all patients perforated without any identified risk factor or prior warning.
Conclusions:
- The incidence of marginal ulcer perforation after LRYGB is significant (>1%).
- Smoking, NSAID use, and steroid use are associated with an increased risk of PMU.
- Long-term ulcer prophylaxis may be warranted for select high-risk patients, given that acute perforation without risk factors is rare (0.2%).
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