Perforated marginal ulcer after gastric bypass for obesity: a systematic review |
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| Affiliation: | 1. Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy;2. Department of General Surgery, University Hospital of North Tees, Stockton-on-Tees, UK;3. Department of General Surgery, Royal Free London NHS Foundation Trust, London, UK;4. Department of General Surgery, Inverclyde Royal Hospital, Greenock, Scotland, UK;5. Department of General Surgery, University Hospital of North Midlands, Stoke-on-Trent, UK;6. Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK;1. Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China;2. Laboratory of Endocrine and the Laboratory of Lipid & Glucose Metabolism, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China;3. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China;1. Department of Surgery, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota;2. Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania;3. Department of Psychiatry, New York University Grossman School of Medicine, New York, New York;4. Advanced Surgical Partners of Virginia, Richmond, Virginia;5. Department of Surgery, Division of Minimally Invasive Bariatric and General Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;6. Massachusetts General Hospital Weight Center, Boston, Massachusetts;7. New York University Langone Medical Center, Division of Bariatric Surgery and Weight Management, New York, New York;1. Department of Obesity and MIS Surgery, New You Medical Center, Riyadh, Saudi Arabia;2. Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia |
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| Abstract: | Marginal ulcers are a recognized complication of gastric bypass procedures for obesity. Perforated marginal ulcer (PMU) is a life-threatening complication of marginal ulcers. We performed a systematic review to understand the presentation, management, and outcomes of PMUs. PubMed, Google Scholar, and Embase databases were searched to identify all studies on PMUs after gastric bypass procedures. A total of 610 patients were identified from 26 articles. The mean age was 39.8±2.59 years, and females represented most of the cohort (67%). The mean body mass index was 43.2±5.67 kg/m2. Most of the patients had undergone a Roux-en-Y gastric bypass (98%). The time gap between the primary bariatric surgery and the diagnosis of PMU was 27.5±8.56 months. The most common presenting symptom was abdominal pain (99.5%) and a computed tomography scan was the diagnostic modality used in 72% of the patients. Only 15% of patients were on prophylactic proton pump inhibitors or H2 blockers at the time of perforation, and 41% of patients were smoking at the time. Twenty-three percent of patients were on nonsteroidal anti-inflammatory drugs. Laparoscopic omental patch repair of the perforation (59%) was the most used technique; 18% of patients underwent open surgery, and 20% were managed non-surgically. Thirty-day mortality was 0.97%; it was 1.21% (n=5) and 0% (n=0) in those who were managed surgically and nonsurgically, respectively. Ulcers recurred in 5% of patients. In conclusion, PMU is a surgical emergency after gastric bypass that can result in significant morbidity and even mortality. This is the first systematic review in scientific literature characterizing this condition. |
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| Keywords: | Marginal ulcer One anastomosis gastric bypass Perforation Roux-en-Y gastric bypass Mini gastric bypass Single-anastomosis gastric bypass Gastric bypass |
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