Marginal ulcers and associated risk factors after Roux-en-Y gastric bypass

Area of Science:

• Bariatric Surgery
• Gastroenterology
• Surgical Complications

Background:

• Morbid obesity prevalence is rising, increasing Roux-en-Y gastric bypass (RYGB) popularity.
• Marginal ulceration is a known long-term risk of RYGB, potentially requiring urgent surgical intervention if perforated.

Purpose of the Study:

• To identify patient characteristics and clinical courses differentiating elective from urgent presentations of marginal ulcers post-RYGB.
• To inform surgical decision-making and patient counseling regarding RYGB complications.

Main Methods:

• Retrospective analysis of 43 patients undergoing surgery for marginal ulcers after RYGB between May 2016 and February 2021.
• Comparison of patient demographics, comorbidities, medications, and clinical outcomes between elective and urgent presentation groups.

Main Results:

• Urgent presentations (perforation) were associated with fewer bleeds and strictures compared to elective cases.
• Urgent presentations led to higher intensive care unit admission rates and significantly longer hospital stays (median 5 vs. 2 days).
• Elective cases underwent resection and reanastomosis, while urgent cases received omental patch repair.

Conclusions:

• Patients presenting urgently with perforated marginal ulcers face increased critical care needs and prolonged hospitalization.
• Bariatric surgeons should emphasize the risk of marginal ulcer perforation during patient counseling to mitigate severe outcomes.
• Early recognition and management strategies are crucial for improving outcomes in post-RYGB marginal ulcer patients.