BACKGROUND: Marginal ulcer formation after Laparoscopic Roux en Y Gastric Bypass (LRYGB) is a known complication. Few studies have clearly identified risk factors and recommendations for prophylaxis have been controversial. METHODS: From July 2001 until January 2006, 764 patients underwent LRYGB for morbid obesity. Prospectively collected data were reviewed and demographic information, co-morbidities, and Body Mass Index (BMI) were retrieved. Bivariate analysis was performed to determine the association between each pre-operative factor and the occurrence of marginal ulcers. Multivariate regression was then performed adjusting for demographics, BMI, and co-morbidities.
RESULTS: Fourteen of the 764 patients developed marginal ulcers (1.83%). From the bivariate analysis, patient demographics were not significant predictors for the development of marginal ulcers. Patients with marginal ulcers were more likely to have hypertension (85.7% vs. 56.8%, p=0.03), hyperlipidemia (57.1% vs. 30%, p=0.029) and sleep apnea (50% vs. 17.9%, p=0.002). Multivariate analysis showed that patients with hyperlipidemia were 3.33 times more likely to develop marginal ulcers (95% CI: 1.02-10.81), while the odds of marginal ulcers in patients with obstructive sleep apnea quadrupled (OR: 4.5, 95%CI: 1.33-15.17).
CONCLUSION: Our data suggests that a subset of the bariatric population having the co-morbidities of hyperlipidemia, sleep apnea, and hypertension may have an increased risk of developing marginal ulcers. Consideration should be given to implementing ulcer prophylaxis in these subsets of patients.
Program Number: P210