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Increased incidence of marginal ulceration following conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: a multi-institutional experience

  • 2022 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Marginal ulcer (MU) formation is a serious complication following Roux-en-Y Gastric Bypass (RYGB). Incidental data suggested a higher incidence of MU following conversion of Sleeve Gastrectomy to RYGB (S-RYGB). Herein, we evaluate the incidence of MU after primary versus secondary RYGB.

Methods

After IRB approval, each institution’s electronic medical record and MBSAQIP database were queried to retrospectively identify adult patients who underwent primary RYGB (P-RYGB), Gastric Banding to RYGB (B-RYGB), or S-RYGB between 2014 and 2019, with minimum 1 year follow-up. Patient demographics, operative data, and post-operative outcomes were compared. Numeric variables were compared via two-sample t test, Wilcoxon test or Kruskal Wallis rank sum test. Two-sample proportion test or Fisher’s exact test was employed for categorical and binary variables. p < 0.05 marked statistical significance.

Results

748 patients underwent RYGB: P-RYGB n = 584 [78.1%]; B-RYGB n = 98 [13.1%]; S-RYGB n = 66 [8.8%]. Most patients were female (83.2%). Mean age was 45.7 years. Forty-six (n = 6.1%) patients developed MU, a median of 14 ± 32.2 months (range 0.5–82) post-operatively. Incidence of MU was significantly higher for patients undergoing S-RYGB (n = 9 [13.6%]), compared to P-RYGB (n = 34 [5.8%]) and B-RYGB (n = 3 [3.1%]) (p = 0.023). Median time (months) to MU was significantly shorter for patients who underwent S-RYGB (5 ± 6) compared to P-RYGB or B-RYGB (19 ± 37.5) (p = 0.035). Among those who developed MU, there was no significant difference in H. pylori status, NSAID, steroid, or tobacco use, irrespective of operation performed.

Conclusion

In this multi-institutional cohort, patients who underwent S-RYGB had a significantly higher incidence of MU than those with P-RYGB or B-RYGB. Further research is needed to elucidate its pathophysiology and prevention strategies.

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Authors and Affiliations

  1. Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA

    Brigitte Anderson, Renee Tholey, Francesco Palazzo, Alec Beekley & Talar Tatarian

  2. Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA

    Tingting Zhan

  3. Department of Surgery, Temple University Hospital, Philadelphia, PA, USA

    Luke Swaszek & Neil King

  4. Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA

    Caroline Sanicola, Aurora Pryor & Konstantinos Spaniolas

  5. Department of Surgery, Thomas Jefferson University, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA

    Talar Tatarian

Authors
  1. Brigitte Anderson
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  2. Tingting Zhan
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  3. Luke Swaszek
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  4. Caroline Sanicola
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  6. Aurora Pryor
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  7. Konstantinos Spaniolas
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Correspondence to Talar Tatarian.

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Disclosures

Aurora D. Pryor reports personal fees from Ethicon, Gore, Merck, Medtronic, and Stryker, grants and personal fees from Obalon, grants from Baronova, outside the submitted work. Konstantinos Spaniolas reports grants from Merck, and is a speaker for Gore outside the submitted work. Brigitte Anderson, Tinting Zhan, Luke Swaszek, Caroline Sanicola, Neil King, Renee Tholey, Francesco Palazzo, Alec Beekley, and Talar Tatarian have no conflicts of interest or financial ties to disclose.

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Anderson, B., Zhan, T., Swaszek, L. et al. Increased incidence of marginal ulceration following conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: a multi-institutional experience. Surg Endosc 37, 3974–3981 (2023). https://doi.org/10.1007/s00464-022-09430-4

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  • DOI: https://doi.org/10.1007/s00464-022-09430-4

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