Revision using totally hand-sewn gastrojejunostomy and truncal vagotomy for refractory marginal ulcer after laparoscopic Roux-en-y gastric bypass: a case series

Chang, Po‐Chih; Huang, Chih‐Kun; Tai, Chi‐Ming; Huang, Ivy Ya-Wei; Hsin, Ming-Che; Hung, Chao‐Ming

doi:10.1016/j.soard.2016.09.035

Cited by 12 publications

(11 citation statements)

References 31 publications

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“…15 Chang et al examined 11 patients who underwent hand-sewn revision of GJ with TV and found that none of the patients had recurrence at a mean follow-up of 28.0 months. 16…”

Section: Discussionmentioning

confidence: 99%

“…15 Chang et al examined 11 patients who underwent hand-sewn revision of GJ with TV and found that none of the patients had recurrence at a mean follow-up of 28.0 months. 16 An international survey of bariatric surgeons indicated that revision of the GJ anastomosis was the preferred method of revision for chronic MU disease. Nonetheless, thoracoscopic TV is also performed as an alternative to GJ revision.…”

Section: Discussionmentioning

confidence: 99%

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Rates of Recurrent Marginal Ulcer in Gastric Bypass Patients Undergoing Revisional Surgery

Pina

Smith

et al. 2023

The American Surgeon™

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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.

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“…15 Chang et al examined 11 patients who underwent hand-sewn revision of GJ with TV and found that none of the patients had recurrence at a mean follow-up of 28.0 months. 16…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rates of Recurrent Marginal Ulcer in Gastric Bypass Patients Undergoing Revisional Surgery

Pina

Smith

et al. 2023

The American Surgeon™

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“…Various techniques for gastrojejunal anastomosis (GJA) exist, with common methods including the use of a linear stapler (LS), circular stapler (CS), and hand-sewn (HS) techniques. Existing data indicates a higher incidence of marginal ulceration (MU) with the CS technique [7,[17][18][19][20] . In a comparison of anastomotic techniques (LS vs. HS) following Roux-en-Y Gastric Bypass (RYGB), Schäfer et al found that MU occurred in 46 patients (19.1%), with significantly higher rates in the CS group (26.2%) compared to the LS group (11.3%) (P = 0.0034) [21] .…”

Section: Anastomotic Techniquementioning

confidence: 99%

“…Following unsuccessful maximal medical therapy, the subsequent course of action involves endoscopic treatment. In a recent investigation by Barola et al [17] , 11 patients grappling with refractory marginal ulcers, despite receiving maximal medical therapy for 6-8 weeks, underwent endoscopic intervention. Despite the study's limited sample size, a noteworthy 90% healing of ulcers was reported post-endoscopic suturing, fully covered self-expandable metal stent (FCSEMS) placement, or a combination of both [17] .…”

Section: Endoscopic Treatmentsmentioning

confidence: 99%

“…In a recent investigation by Barola et al [17] , 11 patients grappling with refractory marginal ulcers, despite receiving maximal medical therapy for 6-8 weeks, underwent endoscopic intervention. Despite the study's limited sample size, a noteworthy 90% healing of ulcers was reported post-endoscopic suturing, fully covered self-expandable metal stent (FCSEMS) placement, or a combination of both [17] . The deciding factor for choosing between endoscopic suturing and FCSEMS hinged on the size of the gastrojejunal anastomosis (GJA); if GJA exceeded 12 mm, endoscopic suturing was performed to envelop the ulcer, while if less than 12 mm, an FCSEMS was utilized.…”

Section: Endoscopic Treatmentsmentioning

confidence: 99%

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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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Management of Marginal Ulcers

Peterson

Kempenich

2019

The ASMBS Textbook of Bariatric Surgery

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Revision using totally hand-sewn gastrojejunostomy and truncal vagotomy for refractory marginal ulcer after laparoscopic Roux-en-y gastric bypass: a case series

Cited by 12 publications

References 31 publications

Rates of Recurrent Marginal Ulcer in Gastric Bypass Patients Undergoing Revisional Surgery

Rates of Recurrent Marginal Ulcer in Gastric Bypass Patients Undergoing Revisional Surgery

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

Management of Marginal Ulcers

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