Complications of Roux-en-Y Gastric Bypass

Kane, Erica D.; Romanelli, John

doi:10.1007/978-3-319-71282-6_33

Cited by 5 publications

(5 citation statements)

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“…The jejunal mucosa, which lacks protective buffering mechanisms, is vulnerable to the effects of gastric secretions [ 25 ]. Local activation of pepsin in the jejunal mucosa is believed to be triggered by the high acidity of gastric secretions, leading to the development of MU [ 26 ]. In addition, the formation of gastrogastric fistula after RYGB has been found to lower the pH in the gastric pouch.…”

Section: Physiopathology and Predictorsmentioning

confidence: 99%

Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management

Salame,

Jawhar,

Belluzzi

et al. 2023

JCM

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Marginal ulcer (MU) is a potential complication following Roux-en-Y gastric bypass (RYGB), with a mean prevalence of 4.6%. Early identification and prompt intervention are crucial to mitigating further complications. The pathophysiology of MU is complex and involves multiple factors, including smoking, Helicobacter pylori infection, non-steroidal anti-inflammatory drug (NSAID) use, and larger pouch size. Patients with MU may experience acute or chronic abdominal pain. Rarely, they may present with a complication from the ulceration, such as bleeding, perforation, or strictures. Following diagnosis by endoscopy, management of MU typically involves modification of risk factors and medical therapy focused on proton pump inhibitors. In case of complicated ulcers, surgical intervention is often required for the repair of the perforation or resection of the stricture. For recurrent or recalcitrant ulcers, endoscopic coverage of the ulcer bed, resection of the anastomosis, and abdominal or thoracoscopic truncal vagotomy may be considered. This review aims at providing an overview of the etiology, diagnosis, and management of MU after RYGB.

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Section: Physiopathology and Predictorsmentioning

confidence: 99%

Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management

Salame,

Jawhar,

Belluzzi

et al. 2023

JCM

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“…Gastro-gastric fistulas occur in 1.5 -6.0 %. The causes of fistulas are insufficient transection of the stomach, tissue ischemia, leakage of intestinal contents into the excluded gastric remnant, the presence of foreign objects (catgut and staples, improper suturing) [40]. Gastro-gastric fistulas usually form 25 days after a diagnosed gastrojejunal anastomotic failure.…”

Section: Reviews оглядиmentioning

confidence: 99%

Early and late complications after gastric bypass: A literature review

Nevmerzhytskyi

2021

ЗХ

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Over the last few decades, excess weight and obesity have become a considerable health problem that has a lasting impact on communities worldwide. According to the WHO, about 1.9 billion people over the age of 18 are overweight [32]. Obesity accounted for about 4.7 million premature deaths in 2017. Globally, obesity was associated with an increase in mortality rate from 4.5 % in 1990 to 8 % in 2017 [32]. Bariatric surgery is currently recognized as the most effective treatment option for morbid obesity. Over the past 10 years, gastric bypass surgery has proved more effective than any other surgical methods due to its optimal metabolic effects. The aim of the review is to carry out an analysis of literature data in order to identify main complications after gastric bypass in patients with obesity. The complication rate after bariatric surgery decreased from 10.5 % in 1993 to 7.6 % in 2006 [3]. The mortality rate after bariatric surgery was 0.08 % within 30 days after surgery and 0.31 % after 30 days [13]. According to the BOLD study (2010), for 57,918 bariatric operations, the complication rate was 6,240 (10.77 %) and the mortality rate was 78 (0.135 %), within 30 days after surgery — 0.089 %, within 90 days after surgery — 0.112 %. Roux‑en‑Y Gastric Bypass (RYGB) was carried out in 30,864 cases, and 4,588 (14.87 %) patients developed postoperative complications. Early complications include anastomotic leaks (0 — 5,6 % for laparoscopic approach and 1,6 — 2,6 % — for laparotomy), small bowel obstruction caused by a blood clot (0 — 0,5 %), bleeding from the sutures (1,5 %), and thromboembolic complications (0,2 — 5 %). Late complications include stenosis of the gastrointestinal tract (3 — 27 %), marginal ulceration (MU) — 0,6 — 16 %, an incarcerated Petersen’s space hernia — 2,51 %, perforation of the stomach and small intestine (1 — 2 %), gastrogastric fistula formation — 1,5 — 6,0 %, weight regain (to 17,1 %). Increasing global demand for bariatric surgery as the best option for the management of excess weight and obesity necessitates more detailed investigation of possible complications it may induce. Therefore, further research is required to develop and study new effective methods for prevention and treatment of complications after surgical treatment of patients with morbid obesity.

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Section: Introductionmentioning

confidence: 99%

“…8 The proposed underlying pathophysiology is thought to be direct jejunal exposure to gastric acid as the jejunum does not secrete a bicarbonate buffer. 9 Hence, factors that lead to higher gastric acid production and/or less bicarbonate protection are associated with an increased risk of marginal ulceration. 10 The main risk factors are thought to be local ischemia from tobacco use, diabetes, previous history of peptic ulcer, alcohol use, presence of a foreign body such as permanent suture or staple causing an ongoing inflammatory reaction, and Helicobacter pylori infection even after its eradication.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, technical aspects of RYGB play a role in the marginal ulceration pathogenesis, which may include a gastric pouch greater than 50 mL leading to increased parietal cell mass, the type of suture material used for the creation of the gastrojejunal anastomosis, and variations in the roux limb path. 9,11 Furthermore, one of the key risk factors remains the use of drugs that change the acid/bicarbonate dynamic in the stomach-the most strongly associated being nonsteroidal anti-inflammatories (NSAIDs). 12 While NSAIDs are widely avoided after the procedure, several patients may require aspirin use for more than just antiinflammatory properties.…”

Section: Introductionmentioning

confidence: 99%

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Aspirin Use as a Risk Factor for Marginal Ulceration in Roux-en-Y Gastric Bypass Patients: A Meta-Analysis of 24,770 Patients

Portela

Sharma

Vahibe

et al. 2022

The American Surgeon™

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Background Roux-en-Y gastric bypass (RYGB) is a recognized, safe bariatric procedure with minimal complications. Marginal ulceration, however, remains a challenging problem with an incidence of 8-12%. While chronic NSAID use is an established risk factor for ulcer formation, aspirin use itself as a cause for marginal ulceration is still unclear. We aim to compare the rates of marginal ulceration in RYGB with and without aspirin use. Methods PubMed, ScienceDirect, Cochrane, Web of Science, and Google Scholar were searched for articles between 2008 and 2021 by two independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The risk of bias was assessed using Newcastle-Ottawa Scale. Meta-analysis was conducted using a fixed-effect model. Results From 5324 studies screened, we included 3 studies. Two studies had a low risk of bias, and the other one presented a high risk of bias on the Newcastle-Ottawa Scale. We included 24,770 patients, 1911 with aspirin use and 22,859 without aspirin use. After the meta-analysis, patients who used aspirin had a significantly higher marginal ulceration rate than those who did not (OR = 1.33 [95% CI 1.08 to 1.63], P < .002; I2 = 39%). Conclusions Aspirin use is associated with increased rates of marginal ulceration after RYGB.

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Complications of Roux-en-Y Gastric Bypass

Cited by 5 publications

References 120 publications

Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management

Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management

Early and late complications after gastric bypass: A literature review

Aspirin Use as a Risk Factor for Marginal Ulceration in Roux-en-Y Gastric Bypass Patients: A Meta-Analysis of 24,770 Patients

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