Revision Gastrojejunostomy Versus Suturing With and Without Omental Patch for Perforated Marginal Ulcer Treatment After Roux-en-Y Gastric Bypass

• Published in: Journal of gastrointestinal surgery Vol. 27; no. 1; pp. 1 - 6
• Main Authors: Crawford, Christopher B., Schuh, Leslie M., Inman, Margaret M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 2023; Springer Nature B.V
• Subjects: Adult; Bariatric Surgery - adverse effects; Female; Gastric Bypass - adverse effects; Gastric Bypass - methods; Gastroenterology; Gastrointestinal surgery; Humans; Laparoscopy - adverse effects; Length of stay; Medicine; Medicine & Public Health; Middle Aged; Obesity, Morbid - complications; Obesity, Morbid - surgery; Original Article; Peptic Ulcer - complications; Peptic Ulcer - surgery; Retrospective Studies; Surgery; Sutures; Treatment Outcome; Ulcer - complications; Ulcer - surgery; Ulcers; Bariatric Surgery; Marginal Ulcer; Gastric Bypass
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-022-05461-3

Background Ulceration at the gastrojejunostomy is a late bariatric surgery complication in 0.6–16% of Roux-en-Y gastric bypass (RYGB) patients. As there is no general consensus on management of acute ulcer perforations, we compare two methods of surgical repair: the most commonly performed procedure, suturing of ulcer with or without omental patch versus revision gastrojejunostomy (RG). Methods A retrospective chart review of cases at a single large, Midwestern US high-volume bariatric center from November 2, 2006 through March 11, 2021 identified 144 RYGB patients undergoing surgical repair for a perforated ulcer: 72 treated by SGP and 72 by RG. Outcomes, including length of stay, leaks, readmissions, and reoperations, were compared. Categorical variables were compared by Chi-square tests and continuous variables by ANOVA. Results Patients were primarily female (77.1%) and Caucasian (97.2%), 49.7 ± 12.5 years old, and 90.6 ± 26.6 kg. Most had laparoscopic RYGBs (98.6%). There were no demographic differences between groups. Of the RG patients, 11.4% experienced ulcer recurrence versus 41.7% of SGP patients ( p  < .001), and 2.8% of RG versus 11.1% of SGP patients required a reversal ( p  < .05). No significant differences between groups occurred in time to perforation (3.2 vs. 2.5 years for RG and SGP groups, respectively), length of stay (5.0 vs. 6.8 days), leaks (1.4% vs. 2.8%), readmissions (4.2% vs. 4.2%), or reoperations (2.8% vs 5.6%). Conclusions Patients developing perforated marginal ulcers after RYGB can be safely and effectively treated by revision gastrojejunostomy with a lower likelihood of ulcer recurrence. Short-term morbidity was comparable to suturing with or without an omental patch.