INTRODUCTION: Perforation of marginal ulcer is a known complication of laparoscopic Roux-en-y gastric bypass (LRYGB), and although not extensively reported in the literature, laparoscopic repair may be a feasible option to avoid the morbidity associated with a large midline laparotomy incision. Our objective is to present our experience with laparoscopic repair of perforated marginal ulcers in patients who have previously undergone LRYGB.
METHODS: A retrospective chart review from August 2005 to April 2007 was performed identifying all patients who underwent laparoscopic repair of perforated marginal ulcer after LRYGB at one hospital by three different surgeons. The perforation was repaired either by laparoscopic primary suture closure followed by application of an omental patch or by laparoscopic Graham patch without primary suture repair. Operative time, duration of hospitalization, post-operative follow-up, post-operative complications, as well as potential risk factors for marginal ulcer formation were recorded.
RESULTS: Six patients underwent laparoscopic repair of a perforated marginal ulcer. Four patients were treated with laparoscopic suture repair and omental patch while two patients were treated with laparoscopic Graham patch without suture repair. Average operative time was 101.8 minutes (SD +/- 50) with an average hospitalization of 5.3 days (SD +/-2.7). Average follow-up was 6.2 months (SD +/-7.5). Post-operative complications included 2 patients with nausea and vomiting related to an exposed suture at the gastrojejunostomy, and one patient developed a stricture at the gastrojejunostomy. All complications were amenable to endoscopic treatment. Three of the six patients were smokers.
CONCLUSIONS: We present the largest series to date of laparoscopic repair of perforated marginal ulcers utilizing an omental patch and describe two techniques for treating these perforations. We demonstrate that a laparoscopic repair can be completed in a reasonable operative time, with minimal post-operative hospitalization and low associated morbidity. We feel that patients who develop a perforated marginal ulcer after LRYGB can be safely and effectively treated with laparoscopic repair with an omental patch.
Program Number: P039