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TRENDS AND OUTCOMES IN MANAGEMENT OF PERFORATED MARGINAL ULCERS IN BARIATRIC SURGERY PATIENTS
John Afthinos1, Aleksandra Ogrodnik*2, Karen E. Gibbs2
1Surgery, Long Island Jewish Forest Hills, Forest Hills, NY; 2Surgery, Staten Island University Hospital, Staten Island, NY
Introduction: Perforated marginal ulcers (PMU) are one of the more common bariatric surgery emergencies. With the rise of bariatric surgery and the frequency of gastric bypass, PMU ulcers can present emergently. We wished to characterize this patient population and the outcomes of operative intervention.
Methods: The National Inpatient Sample (NIS) database was queried for all patients form 2005-2011 admitted for PMU (ICD-9 codes 534.10, 534.11, 534.50 and 534.51) in the setting of having a bariatric surgery history (V45.86). Patients were evaluated for age, gender, comorbid conditions, operative intervention and post-operative complications.
Results: A total of 2,937 patients were identified. The patients were 45.3 + 11 years old and were largely female (82.8%). Obesity was seen in 21% of these patients along with a 25.1% smoking rate. A laparoscopic approach was used in 13.6% of patients and 13% had their gastrojejunostomy revised. Non-operative management was used in 12.7%. Overall morbidity was 8.3% with a low mortality of 0.1%. Length of stay was 6.4 + 4 days. Obesity (OR1.9, p = 0.008) mild liver disease (OR 2.4, p = 0.017) and CHF (OR 6.9, p < 0.001) were predictors of a laparoscopic approach.
Conclusions: PMU ulcers are common bariatric surgical emergencies. Laparoscopic utilization is low in this patient population and mortality is low. There was a moderate rate of revision of the gastrojejunostomy.
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