Predictors of marginal ulcers after laparoscopic Roux-en-Y gastric bypass

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a highly effective therapy for morbid obesity. As the most common postoperative complication, marginal ulcers (MU) present a significant disease burden. The etiology of marginal ulcers after gastric bypass has not been clearly defined. The purpose of this study was to identify independent risk factors for MU.

We performed a retrospective study of a single surgeon's experience performing LRYGB between July 2001 and January 2006 in a United States private practice and university hospital. We investigated patient factors and comorbidities associated with the development of marginal ulcers. The five most common comorbidities were hypertension, type 2 diabetes mellitus, gastroesophageal reflux disease, hyperlipidemia, and obstructive sleep apnea. We analyzed these factors using multivariate logistic regression adjusting for demographics, BMI, and all comorbidities.

In our 763 patients, 89% were female, 84.7% were African-American, and the mean BMI was 50.2 kg/m(2) before surgery. Marginal ulcers occurred in 23 patients (3.01%) over a mean of 64 months. On χ(2) analysis, hypertension, gastroesophageal reflux disease, hyperlipidemia, and sleep apnea were significantly correlated with MU. On multivariate analysis, the odds of marginal ulcer formation were 7.84 among hypertensive patients with a 95% confidence interval of 1.75-35.06 (P = 0.007). Hypertension was the only significant predictor of marginal ulcer disease.

In our study, marginal ulcers occurred more frequently in patients with preoperative hypertension. At higher risk, these patients could be good candidates for extended acid suppression prophylaxis after LRYGB.