TITLE:
Surgical Technique Affects the Incidence of Marginal Ulceration after Roux-en-Y in Gastric Bypass
AUTHORS:
Yong Kwon Lee, Corrigan McBride, Valerie Shostrom, Jon Thompson
KEYWORDS:
Gastric Bypass; Marginal Ulceration
JOURNAL NAME:
Surgical Science,
Vol.4 No.12A,
November
12,
2013
ABSTRACT:
Background: Marginal ulceration (MU) is a recognized
complication of Roux-en-Y gastric bypass (RYGB) surgery. While several possible
risk factors have been reported, the mechanism of MU remains incompletely
understood. The aim of this study was to compare the effect of surgical
technique on the incidence of MU. Methods
and Material: This was a
retrospective study of 749 patients undergoing RYGB over a ten-year period with
at least one year of follow-up. The diagnosis of MU was made based on
clinical symptoms and confirmed by postoperative endoscopy (POE). We assessed
four different gastric bypass (GBP) techniques: T1—Open, non-divided stomach,
circular stapler, non-vagotomy (n = 332); T2—Open, divided stomach, circular
stapler, vagotomy (n = 91); T3—Laparoscopic, divided, circular stapler,
vagotomy (n = 152); T4—Laparoscopic, divided, linear stapler, vagotomy (n = 174). Results: The four groups were similar with respect to age and mean BMI. The
frequency of POE was 16%, 25%, 28% and 27% in groups T1-T4 respectively (NS).
The incidence of MU was significantly lower in T1 (2.1%) compared to T2 (5.5%),
T3 (15.1%) and T4 (12.6%), p 0.05. MU occurred significantly more frequently
with an antecolic Roux limb versus retrocolic (14.5% vs 5.6%, p 0.05). Conclusion: The incidence of MU after RYGB surgery is influenced by surgical
technique. The lowest incidence of MU was with a non-divided stomach, no vagotomy,
transverse staple line, and circular stapled anastomosis. A retrocolic Roux
limb was protective. There was no difference in the incidence of MU using laparoscopic
versus open bypass if a similar technique was employed or using linear versus
circular stapler for the gastrojejunostomy.