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

Crawford, Christopher B.; Schuh, Leslie M.; Inman, Margaret

doi:10.1007/s11605-022-05461-3

Cited by 6 publications

(3 citation statements)

References 13 publications

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“…The prevailing approach for PMU repair frequently involves suturing the ulcer, with or without the use of an omental patch, or revising the Roux-en-Y anastomosis. Notably, the same study has demonstrated that anastomosis revision carries a reduced risk of recurrence [12,13].…”

Section: Introductionmentioning

confidence: 89%

Perforated Marginal Ulcer, Post Roux-En-Y Surgery without Risk Factors: A Case Report

Sabaneh,

Maasher,

Abdul Latif

et al. 2023

IJS

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A marginal ulcer is a commonly occurring complication of Roux-en-Y gastric bypass, with an occurrence rate of up to 16%. However, perforation of such ulcers is rare, affecting approximately 1% of cases and typically manifesting at a later stage. Moreover, risk factors, whether surgical or non-surgical, are present in nearly all patients reported in the literature, with only 0.2% found to have none. This case report focuses on a 32-year-old female patient who presented with severe left-sided abdominal pain. She had a history of undergoing Roux-en-Y surgery two years prior. A CT scan of the abdomen revealed the presence of free air and contrast leak, indicative of a perforated marginal ulcer. The patient subsequently underwent a laparoscopic repair of the marginal ulcer, involving the use of an omental patch. In patients experiencing recurrent abdominal pain, the suspicion of a marginal ulcer should arise, prompting the inclusion of upper endoscopy as part of the diagnostic workup. The feasibility of laparoscopic repair with an omental patch has been demonstrated, and patients are advised to undergo follow-up endoscopy. Doctors should have a high suspicion index for perforation of marginal ulcer with any patient after bariatric surgery despite the absence of risk factors.

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Section: Introductionmentioning

confidence: 89%

Perforated Marginal Ulcer, Post Roux-En-Y Surgery without Risk Factors: A Case Report

Sabaneh,

Maasher,

Abdul Latif

et al. 2023

IJS

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“…Treatment typically involves emergent laparoscopic or open surgery, including oversewing the ulcer, omental patching, and wide drains. However, nonoperative and even endoscopic therapies have also been described in stable patients [72] . Occasionally, extensive revision, such as redoing the gastrojejunal anastomosis, is required.…”

Section: Marginal Ulcer Perforationmentioning

confidence: 99%

Marginal ulceration after Roux-en-Y gastric bypass - literature review and management algorithm

Baldwin,

Ali,

Altieri

et al. 2024

Metab Target Organ Damage

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Roux-en-Y gastric bypass (RYGB)-associated marginal ulceration (MU) poses significant challenges for both patients and clinicians. Persistent symptoms such as epigastric pain, nausea, and reduced oral intake complicate the clinical landscape. MU can lead to severe complications, including anastomotic strictures, bleeding, and perforations. The etiology of MU is intricate, likely stemming from a combination of technical and patient-related factors. Technical considerations involve ischemia, tension on the anastomosis causing tissue ischemia, anastomotic technique, gastric pouch size, foreign bodies, and gastrogastric fistulas. Patient factors encompass smoking, nonsteroidal anti-inflammatory drugs (NSAIDs), Helicobacter pylori (H. pylori), and uncontrolled medical comorbidities. Diagnosis primarily relies on upper endoscopy. Initial treatment typically involves proton pump inhibitors (PPI) and sucralfate. Should these measures prove insufficient, the addition of misoprostol and the implementation of endoscopic techniques, such as oversewing or stenting across the ulcer, may be considered to facilitate healing. Ultimately, if medical and endoscopic interventions fail, surgical options become imperative. These include transthoracic truncal vagotomy and revisional procedures such as resection of the ulcer with redo gastrojejunal anastomosis, resection of the ulcer and pouch with esophagojejunal anastomosis, or resection and reversal to normal anatomy. Surgical interventions demand expertise and should be conducted at qualified, high-volume centers. To support clinicians in comprehending the nuances of MU, we conducted a literature review, presenting a summary of our findings. Additionally, we propose an algorithm delineating the escalation of treatments for MU, ranging from medical to endoscopic to surgical therapies. This concise review aims to assist clinicians in both the prevention and treatment of marginal ulceration.

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“…To tackle these potential complications, a revision GJ can be performed. A recent study by Crawford et al found that revision GJ is a safe and effective approach for perforation after RYGB, with a lower chance of ulcer recurrence and similar short-term morbidity compared to suturing with or without an omental patch [ 86 ]. Our preference is to manage the perforation with omental patching and then decide on anastomotic revision (if needed) in an elective setting.…”

Section: Complicated Ulcersmentioning

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

Cited by 6 publications

References 13 publications

Perforated Marginal Ulcer, Post Roux-En-Y Surgery without Risk Factors: A Case Report

Perforated Marginal Ulcer, Post Roux-En-Y Surgery without Risk Factors: A Case Report

Marginal ulceration after Roux-en-Y gastric bypass - literature review and management algorithm

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

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