Surgical Technique Affects the Incidence of Marginal Ulceration After Roux-En-Y Gastric Bypass
Yong-Kwon Lee*, Jon S. Thompson, Valerie Shostrom, Corrigan L. Mcbride
University Nebraska Medical Center, Omaha, NE
BackgroundMarginal ulceration (MU) is an increasingly recognized complication of Roux-en-Y gastric bypass (RYGBP) surgery. Several possible risk factors have been reported. However, the mechanism of this is poorly understood. The aim of this study is to compare the effect of surgical technique on the incidence of marginal ulceration.Methods and Material This is a retrospective study of 752 patient undergoing RYGBP over a ten year period with at least 1 year of follow up. The diagnosis of MU was made based on clinical symptoms and confirmed by endoscopy. We assessed four different RYGBP techniques (T1: Open, non-divided stomach, TA 90-B transverse, circular stapler, non-vagotomy; T2: Open, divided, GIA vertical, circular stapler, vagotomy; T3: Laparoscopic, divided, GIA, circular staple, vagotomy; T4: Laparoscopic, divided, GIA, linear stapler, vagotomy). Parameters evaluated included demographics, risk factors, number of post operative endoscopy (POE) and number MU. Incidence of MU was compared among groups using the log-rank testResultsTable 1 Clinical CharacteristicsTechniques T1 T2 T3 T4Number of cases 334 91 152 175Mean BMI (range) 51.8 (36-88) 52.2 (36-76) 52.1 (32-78) 50.8 (36-79)Mean age (range) years 47 (25-72) 44 (25-71) 44 (22-74) 46 (26-71)Gender (% of Female) 88.3 78 91.4 88.6POE number (%) 54 (16.2) 23 (25.3) 43 (28.3) 48 (27.4)Number of Marginal Ulcer (%) 7 (2.1) 5 (5.5)* 23 (15.1)* 22 (12.6)**p-value <0.05 compared to T1 ConclusionThe incidence of MU after RYGBP surgery is influenced by surgical technique. The overall 7.5% incidence of MU is consistent with other studies. The lowest incidence of MU was with a non-divided stomach, no vagotomy and transverse staple line. There was no difference in MU using linear or circular stapler for the gastrojejunostomy and no difference in laparoscopic versus open bypass if a similar technique was employed.
Clinical Characteristics
| Techniques | T1 | T2 | T3 | T4 |
| Number of cases | 334 | 91 | 152 | 175 |
| Mean BMI (range) | 51.8 (36-88) | 52.2 (36-76) | 52.1 (32-78) | 50.8 (36-79) |
| Mean age (range) years | 47 (25-72) | 44 (25-71) | 44 (22-74) | 46 (26-71) |
| Gender (% of Female) | 88.3 | 78 | 91.4 | 88.6 |
| POE number (%) | 54 (16.2) | 23 (25.3) | 43 (28.3) | 48 (27.4) |
| Number of Marginal Ulcer (%) | 7 (2.1) | 5 (5.5)* | 23 (15.1)* | 22 (12.6)* |
*p-value <0.05 compared to T1
