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High Rates of Nicotine Use Relapse and Ulcer Development Following Roux-en-Y Gastric Bypass

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Abstract

Purpose

Given that smoking is known to contribute to gastrojejunal anastomotic (GJA) ulcers, cessation is recommended prior to laparoscopic Roux-en-Y gastric bypass (LRYGB). However, smoking relapse rates and the exact ulcer risk remain unknown. This study aimed to define smoking relapse, risk of GJA ulceration, and complications after LRYGB.

Materials and Methods

We performed a retrospective cohort study of patients who underwent primary LRYGB during 2011–2015. Initially, three patient categories were identified: lifetime non-smokers, patients who were smoking during the initial visit at the bariatric clinic or within the prior year (recent smokers), and patients who had ceased smoking more than a year prior to their initial clinic visit (former smokers). Smoking relapse, GJA ulcer occurrences, reinterventions, and reoperations were recorded and compared.

Results

A total of 766 patients were included in the analysis. After surgery, 53 (64.6%) recent smokers had resumed smoking. Out of these relapsed smokers, 51% developed GJA ulcers compared with 14.8% in non-relapsed recent smokers, 16.1% in former smokers, and 6% in lifetime nonsmokers (p < 0.001). Furthermore, relapsed smokers required more frequently endoscopic reinterventions (60.4%) compared with non-relapsed smokers (20.8%, p < 0.001), former smokers (20.7%, p < 0.001), and lifetime non-smokers (15.4%, p < 0.001). Additionally, relapsed smokers required a reoperation (18.9%) more often than non-relapsed recent smokers (5.7%, p < 0.001) and lifetime non-smokers (1.3%, p < 0.001).

Conclusion

Smokers relapse frequently after LRYGB, and the majority experience GJA complications. They should be counseled about this risk preoperatively and directed towards less ulcerogenic procedures when possible. Alternatively, longer periods of preoperative smoking abstinence might be needed.

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Author notes

  1. Alexei Christodoulides and Sara Monfared contributed equally and share the second co-authorship.

Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA

    Dimitrios I. Athanasiadis, Sara Monfared & Dimitrios Stefanidis

  2. Indiana University School of Medicine, Indianapolis, IN, USA

    Alexei Christodoulides

  3. Department of Surgery, Indiana University Health, Indianapolis, IN, USA

    William Hilgendorf, Marisa Embry & Dimitrios Stefanidis

Authors
  1. Dimitrios I. Athanasiadis
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  2. Alexei Christodoulides
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  3. Sara Monfared
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  4. William Hilgendorf
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  6. Dimitrios Stefanidis
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Correspondence to Dimitrios Stefanidis.

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Athanasiadis, D.I., Christodoulides, A., Monfared, S. et al. High Rates of Nicotine Use Relapse and Ulcer Development Following Roux-en-Y Gastric Bypass. OBES SURG 31, 640–645 (2021). https://doi.org/10.1007/s11695-020-04978-3

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  • DOI: https://doi.org/10.1007/s11695-020-04978-3

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