Introduction The rate of marginal ulcer (MU) following primary Roux-en-Y Gastric Bypass (RYGB) is approximately .6-16%. Few studies have evaluated recurrence rates following surgical revision for MU. The primary aim of this study was to determine the rate of MU recurrence following revision. The secondary aim was to evaluate the impact of truncal vagotomy (TV) on the recurrence rates and analyze potential risk factors associated with the recurrence of MU after revision. Methods We conducted a retrospective cohort study examining data at a single tertiary academic medical center. Adult patients with a history of RYGB who underwent gastrojejunostomy revision for recurrent MU between the years of 2003-2020 were included. We sought to determine our overall rate of MU following revision, with and without TV. Additionally, we examined the association of risk factors with MU recurrence. Fisher’s exact test was used to determine the statistical significance of recurrence rates between the groups. Results We included 90 patients in the study. The overall recurrence rate for MU was 16.7%. Of the 90 patients, 35 (35.4%) patients underwent TV at the time of revision. The recurrence rate of MU after GJ revision with TV was 14.3% in comparison to those without TV, 18.2% ( P = .775). Smoking, steroid, alcohol use, history of cardiac surgery/intervention, and helicobacter pylori were not significantly associated with recurrent MU following revision. Conclusions The rate of recurrence after revision for MU is high. Adding TV trended towards decreased MU recurrence after revisional surgery, however not significant. Larger studies are needed to evaluate risk factors associated with recurrent MU after revision.

Background Type 2 Diabetes Mellitus (T2DM) is highly prevalent comorbidity in patients with morbid obesity. It is still unclear whether a cutoff value of preoperative A1c represents an increased risk for major postoperative complications following Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG). Methods Retrospective MBSAQIP Participant Use File cohort for both years 2017 and 2018 were analyzed to evaluate the relationship between HbA1c in patients with morbid obesity and T2DM undergoing bariatric surgery, and the 30 days postoperative major complications by Clavien-Dindo classification (III/IV). We used an HbA1c cutoff of <7, > =7, and stratified by 1% increment for a total of 11 groups. We used univariate and multivariate logistic regression to analyze the outcome of the complications. Predicted probabilities were calculated for major complications. All statistical tests were two-sided with a P-value of less than .05 considered as a cut-off for statistical significance. Results Of 42,181 patients that met inclusion criteria, there were 20,955 identified with HbA1c <7%, and 21,226 patients with HbA1c >7%. Utilizing HbA1c <7% as a cutoff, we found no consistent statistical significance in the major postoperative complication in patients with HbA1c >7%, and when stratified with 1% increment between groups. We also found no significance between groups with risk adjustment. Conclusions Extensive analysis of the large MBSAQIP cohort didn’t result in a clinically significant association between stratified HbA1c and 30-day Clavien-Dindo major complications (III/IV) following Roux-en-Y Gastric Bypass (RYGB) and (SG).