Marginal ulcer rates in primary Roux-en-Y gastric bypass versus conversion of sleeve gastrectomy to Roux-en-Y gastric...

Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are well-established surgical interventions for morbid obesity, offering significant weight loss and improvement or resolution of many obesity-related comorbidities. Some patients who initially undergo SG later elect to convert to RYGB due to inadequate weight loss. Marginal ulcers (MUs), characterized by ulceration at the gastrojejunal anastomosis, are a known and prevalent complication following RYGB.

This retrospective study was conducted at a single community hospital. Records were reviewed to identify patients who underwent either primary or conversion RYGB between 2015 and 2023. Data collected included patient demographics, perioperative variables, relevant risk factors, and incidence of gastrojejunal anastomotic ulcers, diagnosed via endoscopy or computed tomography scans.

A total of 113 patients were included in this study, with 49.6% of them undergoing primary RYGB and 50.4% undergoing conversion RYGB. No significant differences were found between groups in preoperative weight, BMI, ASA status, or other preoperative risk factors. However, there were significant differences in racial distribution between the groups-the primary RYGB group included 69.6% Black or African American patients while the conversion RYGB group consisted of 86% Black or African American patients (p = 0.037). Comparatively, the primary RYGB group consisted of 28.6% White patients while only 8.8% of the patients in the conversion RYGB group were White.(p = 0.007). The incidence of marginal ulceration was not significantly different between the groups (21.4% in the primary group vs. 24.6% in the conversion group; p = 0.69).

No differences were observed in the rates of marginal ulceration in patients in the group who underwent primary Roux-en-Y gastric bypass surgery versus those who underwent conversion RYGB from a previous SG. This study's results contradict the results of some similar studies and challenge the hypothesis that the gastric anatomical changes after SG could possibly result in significantly compromised perfusion, thus increasing the risk of marginal ulceration. The discrepancy between our results and previous reports highlights the need for further research to clarify the underlying mechanisms and risk factors contributing to marginal ulcer development in various surgical contexts.