Thoracoscopic truncal vagotomy versus surgical revision of the gastrojejunal anastomosis for recalcitrant marginal ulcers

Bonanno, Alicia M.; Tieu, Brandon H.; Dewey, Elizabeth; Husain, Farah

doi:10.1007/s00464-018-6386-7

Cited by 14 publications

(7 citation statements)

References 13 publications

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“…Treatment of marginal ulcer consists of elimination of risk factors, PPI, and regular endoscopic monitoring 9 . They are rarely refractory to medical management which brings up the necessity of revision surgery that includes resection and reconstruction of anastomosis 9,10 . Emergency laparotomy is necessary when patient presents with perforation of marginal ulcer; perforated ulcer can be managed with simple closure and omental patch closure 1,9 .…”

Section: Discussionmentioning

confidence: 99%

Perforated marginal ulcer following Whipple procedure: A case report

Rijal¹,

Awal

Basukala

et al. 2023

Clinical Case Reports

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Section: Discussionmentioning

confidence: 99%

Perforated marginal ulcer following Whipple procedure: A case report

Rijal¹,

Awal

Basukala

et al. 2023

Clinical Case Reports

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Section: Discussionmentioning

confidence: 99%

“…The authors found no significant difference in recurrence rate (15% vs 14%, P = .2575) in their cohort of 20 patients. 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.…”

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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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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“…For patients resistant to marginal ulcer treatment, even with appropriate measures, truncal vagotomy may present itself as a viable stand-alone strategy for healing before considering anastomotic revision. Truncal vagotomy, first described in 1947 for healing a GJA ulcer [87] , can be conducted either laparoscopically [88] or thoracoscopically [89][90][91] . In a study by Bonanno et al [90] , where 20 patients with resistant marginal ulceration underwent either GJA revision or thoracoscopic truncal vagotomy (TTV), results indicated comparable ulcer recurrence rates between GJ revisions (15%) and TTV (14%).…”

Section: Truncal Vagotomymentioning

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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Thoracoscopic truncal vagotomy versus surgical revision of the gastrojejunal anastomosis for recalcitrant marginal ulcers

Cited by 14 publications

References 13 publications

Perforated marginal ulcer following Whipple procedure: A case report

Perforated marginal ulcer following Whipple procedure: A case report

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

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