PMID- 24462313
OWN - NLM
STAT- MEDLINE
DCOM- 20141210
LR  - 20140331
IS  - 1878-7533 (Electronic)
IS  - 1550-7289 (Linking)
VI  - 10
IP  - 2
DP  - 2014 Mar-Apr
TI  - Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric 
      bypass at a single high volume bariatric center.
PG  - 229-34
LID - S1550-7289(13)00326-2 [pii]
LID - 10.1016/j.soard.2013.10.002 [doi]
AB  - BACKGROUND: Marginal ulceration (MU) is one of the most common complications 
      after Roux-en-Y gastric bypass (RYGB). However, the rate of MU varies from 1% to 
      16% of RYGB patients and predisposing factors remain unclear. The aim of this 
      study is to describe frequency, management, and outcomes of treatment in patients 
      with MU after laparoscopic RYGB. METHODS: Between January 2004 and December 2012, 
      a total of 2,535 patients underwent laparoscopic RYGB at our institution. 
      Patients were routinely placed on proton pump inhibitors (PPI) for 90 days after 
      the procedure. A total of 59 (2.3%) patients presented with MU. A retrospective 
      review of a prospectively collected database was performed for all patients. 
      RESULTS: Patients with MU presented with abdominal pain (n = 35), nausea/vomiting 
      (n = 9), anemia (n = 5), hematemesis (n = 5), and dysphagia (n = 5) as chief 
      complaints. Diagnosis was made at a mean period of 15.2 +/- 17.4 months (range, 
      1-64) after the laparoscopic RYGB. Of these patients, 26 (44.1%) required 
      reoperations including 12 (20.3%) with perforated ulcers. Urgent operation was 
      required in 14 (23.7%) patients due to perforation or active bleeding, and 
      elective operation was performed in 10 (16.9%) patients for chronic and 
      refractory MU or gastrogastric fistula. One (1.7%) patient developed recurrent MU 
      after the revision and had another revision of the anastomosis. One (1.7%) 
      patient underwent reversal of gastric bypass after the revision due to 
      malnutrition and recurrent ulcers. All patients did well at a mean follow up of 
      28.9 +/- 21.7 months (range, 1-78 mo). CONCLUSION: Despite the use of routine PPI, 
      the incidence of MU was not insignificant. A significant portion of patients 
      required surgical treatment. Perforations can be effectively managed by 
      oversewing of the ulcer.
CI  - (c) 2014 American Society for Bariatric Surgery Published by American Society for 
      Metabolic and Bariatric Surgery All rights reserved.
FAU - Moon, Rena C
AU  - Moon RC
AD  - Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and 
      Laparoscopy Center, Orlando Health.
FAU - Teixeira, Andre F
AU  - Teixeira AF
AD  - Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and 
      Laparoscopy Center, Orlando Health.
FAU - Goldbach, Michael
AU  - Goldbach M
AD  - Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and 
      Laparoscopy Center, Orlando Health.
FAU - Jawad, Muhammad A
AU  - Jawad MA
AD  - Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and 
      Laparoscopy Center, Orlando Health. Electronic address: 
      muhammad.jawad@orlandohealth.com.
LA  - eng
PT  - Journal Article
DEP - 20131011
PL  - United States
TA  - Surg Obes Relat Dis
JT  - Surgery for obesity and related diseases : official journal of the American 
      Society for Bariatric Surgery
JID - 101233161
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Female
MH  - Florida/epidemiology
MH  - Follow-Up Studies
MH  - Gastric Bypass/*adverse effects/methods
MH  - Hospitals, High-Volume/*statistics & numerical data
MH  - Humans
MH  - Laparoscopy/adverse effects
MH  - Male
MH  - Middle Aged
MH  - Peptic Ulcer/epidemiology/etiology/*therapy
MH  - *Postoperative Complications
MH  - Prevalence
MH  - Prognosis
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Reoperation
MH  - Retrospective Studies
MH  - Young Adult
OTO - NOTNLM
OT  - Complication
OT  - Gastric bypass
OT  - Marginal ulcer
OT  - Perforated ulcer
EDAT- 2014/01/28 06:00
MHDA- 2014/12/15 06:00
CRDT- 2014/01/28 06:00
PHST- 2013/07/16 00:00 [received]
PHST- 2013/09/16 00:00 [revised]
PHST- 2013/10/01 00:00 [accepted]
PHST- 2014/01/28 06:00 [entrez]
PHST- 2014/01/28 06:00 [pubmed]
PHST- 2014/12/15 06:00 [medline]
AID - S1550-7289(13)00326-2 [pii]
AID - 10.1016/j.soard.2013.10.002 [doi]
PST - ppublish
SO  - Surg Obes Relat Dis. 2014 Mar-Apr;10(2):229-34. doi: 10.1016/j.soard.2013.10.002. 
      Epub 2013 Oct 11.