Owen Pyke, MD, MPH, MBA, Konstantinos Spaniolas, MD, Salvatore Docimo, DO, MS, Mark A Talamini, MD, MBA, Andrew T Bates, MD, Aurora Pryor, MD, FACS, FASMBS. Stony Brook University Medical Center
INTRODUCTION: Marginal ulcerations (MU) are a common and concerning complication following Roux-en-Y gastric bypass (RYGB) surgery. Importantly, the clinical impact of MU remains unclear, since this complication can often respond to medical therapy alone. The aim of the present study was to examine the progression of MU and construct a prognostic scheme for the need for surgical intervention in patients with MU following RYGB.
METHODS AND PROCEDURES: A New York state longitudinal administrative database was queried to identify patients who underwent RYGB between 2005-2010 and who were followed for at least 4 years for the development of MU using ICD-9 and CPT codes. Patients with perforation as their first presentation of MU were excluded. Multivariable Cox proportional regression models were built to identify risk factors for surgical intervention (revision or repair). Odds ratios (OR) or hazard ratio (HR) with 95% confidence intervals (CI) are reported as indicated.
RESULTS: We identified 35,075 patients who underwent RYGB. Mean age was 42.2±10.9years, and the majority was female (81.08%). 2,201 (6.28%) patients were diagnosed with MU, and 204 (9.27% of MU; 0.58% of entire RYGB cohort) required a surgical intervention 248 (interquartile range 51-824) days after MU diagnosis. The estimated cumulative incidence (95% CI) of having surgical intervention at 1, 2, 5 and 8 years after MU diagnosis was 6% (5-7%), 8% (7-9%), 13% (11-14%), and 17% (13-20%), respectively (Figure). At time of MU diagnosis, younger patients (HR 0.93 for every increasing 5 years, 95% CI 0.87-0.99) of white race (HR 1.6, 95% CI 1.15-2.23), and profound weight loss (HR 2.82, 95% CI 1.62-4.88) were independent risk factors for subsequent surgical intervention for MU. Estimated cumulative incidence of MU recurrence was 15% (9-22%) and 24% (15-32%) at 6 and 12 months after surgical intervention.
CONCLUSION(S): The need for surgical intervention for MU after RYGB is uncommon. Patients of young age, white race and marked weight loss are at higher risk for surgical intervention, and may potentially benefit from early intensive medical therapy at the time of MU diagnosis. Importantly, MU recurrence is very common after medical or surgical intervention, and patients may possibly benefit from prolonged medical prophylaxis. Studies of intervention for MU require long-term follow-up as the incidence of surgical intervention increases yearly.
Cumulative incidence of surgical intervention for MU after initial non-performed MU diagnosis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87740
Program Number: S041
Presentation Session: Bariatrics 2 Session
Presentation Type: Podium