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Obesity Surgery

, Volume 8, Issue 5, pp 505–516 | Cite as

Marginal Ulcer After Gastric Bypass: A Prospective 3-Year Study of 173 Patients

  • James A Sapala
  • Michael H Wood
  • M Andrew Sapala
  • Thomas M FlakeJr.
Article

Background: Marginal ulceration (MU) after Roux-en-Y gastric bypass (RYGB) is a well-recognized complication. Its incidence varies between 1% and 16%. Factors associated with the development of MU include pouch size, pouch orientation, staple line integrity, and mucosal ischemia. Nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori may also contribute to MU, but their mechanism of action in the RYGB patient has not been studied. Methods: In 1994 a prospective 3-year study was designed to document the incidence of MU after near-total gastric bypass (NTGB). In this procedure the transected pouch was limited to the cardia, and the gastrojejunostomy was made along the greater curvature. A total of 173 patients entered the study. All patients who experienced postoperative nausea, vomiting, or abdominal pain underwent endoscopic examination of the pouch, stoma, and proximal Roux-en-Y limb. Gastrograffin studies were used within the first 2 weeks of operation. Results: One year after operation, MU was not identified in any patient. At 3 years follow-up, MU was documented in one patient (0.6%) with a dilated gastric reservoir (60 cc). Conclusion: This study reviews the etiology, diagnosis, and treatment of MU in the RYGB patient and offers specific recommendations to reduce its occurrence. It also confirms a preliminary impression that NTGB is an effective operation in preventing MU formation.

Gastric bypass Roux-en-Y marginal ulceration Helicobacter pylori morbid obesity 

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Copyright information

© Springer 1998

Authors and Affiliations

  • James A Sapala
    • Michael H Wood
      • M Andrew Sapala
        • Thomas M FlakeJr.

          There are no affiliations available

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