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The natural history of perforated marginal ulcers after gastric bypass surgery

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Abstract

Introduction

Although perforated marginal ulcers (pMU) following Roux-en-Y Gastric Bypass (RYGB) represent a surgical emergency, the epidemiology and outcome of this condition is not well understood. The purpose of this study was to evaluate incidence of pMU following RYGB and assess the natural history of this complication.

Methods

The SPARCS administrative database was used to identify patients undergoing RYGB between 2005 and 2010. With the use of a unique identifier, we followed patients up to 2014 for subsequent admission and re-intervention (repair or revision) for perforated MU. Groups were compared using Chi square tests with exact p values based on Monte Carlo simulation, t test with unequal variances, and the Wilcoxon rank-sum test when appropriate.

Results

We identified 35,080 RYGB patients; 292 patients (0.83%) developed pMU 937 (443–1546) days following RYGB [Median (Q1–Q3)]. Among these 292 patients, tobacco use was present in one-third of patients. Repair of the perforation was performed in 115 patients, while anastomotic revision was reported in 64. Patients who underwent revision were more likely to have respiratory complications. Hospital length of stay was significantly longer for patients managed with RYGB revision (Median, Q1–Q3:7, 5–14, vs 6, 4–7, days, p = 0.001). Recurrence of marginal ulcer was common after either intervention (26.09% for repair and 29.69% for revision, p = 0.726).

Conclusion

Following RYGB, the incidence of pMU is small. Anastomotic revision for pMU is associated with prolonged length of stay compared to repair alone. Importantly, recurrence after intervention of pMU is common, suggesting possible value of a routine surveillance program for patients following pMU.

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Acknowledgement

We acknowledge the biostatistical consultation and support provided by the Biostatistical Consulting Core at School of Medicine, Stony Brook University.

Funding

No industry or other external funding was used for this research.

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Authors and Affiliations

  1. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA

    Maria S. Altieri, Aurora Pryor, Salvatore Docimo, Andrew Bates, Mark Talamini & Konstantinos Spaniolas

  2. Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

    Jie Yang

  3. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA

    Donglei Yin

Authors
  1. Maria S. Altieri
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  2. Aurora Pryor
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  3. Jie Yang
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  4. Donglei Yin
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  5. Salvatore Docimo
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  6. Andrew Bates
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  7. Mark Talamini
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  8. Konstantinos Spaniolas
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Corresponding author

Correspondence to Maria S. Altieri.

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Disclosures

Dr. Pryor receives honoraria for speaking for Ethicon, Medtronic, Stryker, and Gore; is a consultant for Medicines Company, Merck, and Intuitive, and has ownership interest in Transenterix. Maria S. Altieri, Jie Yang, Donglei Yin, Salvatore Docimo, Andrew Bates, Mark Talamini, Konstantinos Spaniolas have no conflicts of interest or financial ties to disclose.

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Altieri, M.S., Pryor, A., Yang, J. et al. The natural history of perforated marginal ulcers after gastric bypass surgery. Surg Endosc 32, 1215–1222 (2018). https://doi.org/10.1007/s00464-017-5794-4

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  • DOI: https://doi.org/10.1007/s00464-017-5794-4

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