Perforating marginal ulcers after laparoscopic gastric bypass

Lublin, Matthew; McCoy, McHuy F; Waldrep, Donald J.

doi:10.1007/s00464-005-0325-0

Cited by 44 publications

(25 citation statements)

References 16 publications

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“…An ideal management of super-obese patients does not exist, but gastric bypass is one of the most common procedures with the best results concerning efficacy, morbidity and mortality [1][2][3][4][5][6][7]. If a decision for gastric bypass is made after the relevant preoperative diagnostics (body mass index, comorbidities, diabetes mellitus), the surgeon has a choice between Roux-en-Y and B-II gastric bypass.…”

Section: Introductionmentioning

confidence: 99%

Two Important Criteria for Reducing the Risk of Postoperative Ulcers at the Gastrojejunostomy Site after Gastric Bypass: Patient Compliance and Type of Gastric Bypass

Scheffel

Daskalakis

Weiner³

2011

Obes Facts

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SummaryBackground: Ulcers at the gastrojejunostomy site are a common problem after gastric surgery. Their postoperative development seems to be associated with Helicobacter pylori-related gastritis or abuse of nicotine, alcohol or non-steroidal anti-inflammatory drugs (NSAIDs), but is also dependent on the choice of surgical method (Roux-en-Y or B-II gastric bypass). Patients and Methods: This study evaluated the follow-up of 1,908 patients over a period of 5 years (January 2006 to December 2010). In 1,861 cases, we performed a Roux-en-Y gastric bypass, and in 47 cases a B-II gastric bypass. Results: All patients (n = 407) with symptoms such as dysphagia, reflux, nausea, vomiting or epigastric pain underwent gastroscopy. In 52 cases, ulcers were found at the gastrojejunostomy site. Of these patients, 39 (75%; p < 0.0001) had consumed alcohol, nicotine or NSAIDs; in 14 patients (27%; p < 0.0001) we detected H. pylori-related gastritis. A total of 2.4% of the patients after Roux-en-Y gastric bypass (45/1,861) and 14.9% of the patients after B-II gastric bypass (7/47) developed ulcers at the gastroenteral junction. The difference is clearly significant (Fisher's exact test, p = 0.0002). Furthermore, there were signi ficant differences regarding the recurrence rate: 86% of the B-II gastric bypass group and 13.3% of the Roux-en-Y gastric bypass group needed to be treated several times. Conclusions: Every patient needs to be informed preoperatively that there is a markedly increased risk of ulcers at the gastroenteral junction, particularly if the patient cannot avoid potential risk factors (nicotine, alcohol, NSAIDs). Preoperative gastroscopy with H. pylori testing and subsequent eradication can also reduce the risk of ulcers. An increased incidence of peptic ulcers after B-II gastric bypass was noted. All of these patients were converted to Roux-en-Y.

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Section: Introductionmentioning

confidence: 99%

Two Important Criteria for Reducing the Risk of Postoperative Ulcers at the Gastrojejunostomy Site after Gastric Bypass: Patient Compliance and Type of Gastric Bypass

Scheffel

Daskalakis

Weiner³

2011

Obes Facts

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“…La perforación es un evento grave que suele requerir una reoperación, por lo que se deben hacer todos los esfuerzos para evitar esta complicación. La probabilidad de perforación de una úlcera marginal es baja, describiéndose una prevalencia entre un 0,4 a 0,8% 7,15,17,[19][20][21][22][23] , concordando lo informado en este trabajo con la literatura. Al ser un grupo pequeño de pacientes, los factores asociados al desarrollo de esta complicación se encuentran menos estudiados, sin embargo, algunos tienden a repetirse en las distintas series.…”

Section: Figuraunclassified

“…nuestra experiencia ha demostrado que el tratamiento quirúrgico por vía laparoscópica de estos pacientes es una alternativa muy útil y segura, sin morbi-mortalidad en nuestra serie, sin embargo, experiencias similares han informado morbilidad y mortalidad del 30% y 10%, respectivamente 23 . La técnica empleada, consistente en aseo peritoneal y posterior rafia de la lesión en un solo plano con material de sutura no reabsorbible.…”

Section: Figuraunclassified

“…La técnica empleada, consistente en aseo peritoneal y posterior rafia de la lesión en un solo plano con material de sutura no reabsorbible. Esto nos parece adecuado y suficiente, sin tener que requerir parches de epiplón 7,17,21,22,[25][26][27][28] o ligamento 23 o tener que incluir el uso de sellantes de fibrina sobre la sutura 23,26 . Finalmente, la perforación de una úlcera marginal post BPGLP es un hecho poco frecuente, sin embargo, debemos estar atentos a su ocurrencia ya que la mayoría de los pacientes presentan factores de riesgo fácilmente identificables y modificables, lo que permitiría prevenir esta grave complicación que implica una cirugía y eventualmente morbi-mortalidad.…”

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Úlcera Marginal Perforada Post Bypass Gástrico Laparoscópico

et al. 2015

Rev Chil Cir

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Perforated marginal ulcer after laparoscopic gastric bypass introduction: Perforated marginal ulcer is a serious event that usually requires reoperation and is associated with morbidity and mortality. Characterization and management of these patients is still debated. Objective: To describe a series of patients subjected to a laparoscopic gastric bypass (LGBP) that evolved with a perforated marginal ulcer. material and methods: Records of patients undergoing a LGBP the last 10 years and evolved with a perforated marginal ulcer were retrospectively reviewed. Clinical features, treatment and perioperative morbidity and mortality were analyzed. results: During this period 2,095 patients were subjected to a LGBP, 12 of them presented a perforated marginal ulcer, corresponding to 10 women and 2 men. Mean age was 39 (21-60) and mean body mass index at the time of initial surgery was 34 (29.3 to 38.6). Ten patients were smoker at the moment of perforation. The occurrence of this happened at a mean of 27 months (range 3-54, median 23.5) after surgery. Eleven cases had a surgical resolution, with a laparoscopic approach in 9 of them and laparotomy on 2. In all cases, a perforated ulcer in the jejunal side of the gastrojejunal anastomosis was found. There was no mortality or morbidity associated with surgery. conclusions: In our experience the occurrence of perforated marginal ulcer after a LGBP develops in a small percentage of patients. The laparoscopic approach is of choice, presenting a low morbidity and mortality. Smoking was present in most patients.

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“…Its incidence without perforation ranges from more than 30% after simple gastroenterostomy (GE) to less than 1% after vagotomy (VT) and resection [2], whereas it varies 1-16% for bariatric surgical procedures [3]. MU is distinctly more common in men than in women [2].…”

Section: Introductionmentioning

confidence: 99%

Is perforated marginal ulcer after the surgery of gastroduodenal ulcer associated with inadequate treatment for Helicobacter pylori eradication?

Aydınlı

Yılmaz

Öztürk

et al. 2007

Langenbecks Arch Surg

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Perforating marginal ulcers after laparoscopic gastric bypass

Abstract: Although the etiology is unclear, marginal ulcers, a known complication of gastrojejunostomy, may present as perforating ulcers after LGB in a characteristic fashion and can be managed laparoscopically.

Cited by 44 publications

References 16 publications

Two Important Criteria for Reducing the Risk of Postoperative Ulcers at the Gastrojejunostomy Site after Gastric Bypass: Patient Compliance and Type of Gastric Bypass

Two Important Criteria for Reducing the Risk of Postoperative Ulcers at the Gastrojejunostomy Site after Gastric Bypass: Patient Compliance and Type of Gastric Bypass

Úlcera Marginal Perforada Post Bypass Gástrico Laparoscópico

Is perforated marginal ulcer after the surgery of gastroduodenal ulcer associated with inadequate treatment for Helicobacter pylori eradication?

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