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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
Surgical Endoscopy
|June 17, 2008
Summary
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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