Mark D Ringle, Priscila R Armijo, MD, Dietric Hennings, MD, Tiffany Tanner, MD, Dmitry Oleynikov, MD, Corrigan L McBride, MD, Vishal Kothari, MD. University of Nebraska Medical Center
Introduction: Ulceration and stricture are known complications following Roux-en-Y gastric bypass (RYGB). Often these complications significantly impact the patient’s continued care including strictures and marginal ulcers. This study aimed to determine the prevalence of ulceration, gastritis and stricture after linear stapled RYGB and identify predictors that may increase the risk of one or more of these complications.
Methods: A single-institution prospectively collected database was reviewed for patients who underwent primary RYGB between 2012 and 2014. The patients were divided according to presence (C) or absence (NC) of a postoperative complication. These were defined as presence of marginal ulcer, gastritis, or stricture during the postoperative period (15.3±8.9 months). Demographics, preoperative BMI, and comorbidities, including diabetes, obstructive sleep apnea, gastroesophageal reflux disease, hypertension and hyperlipidemia were evaluated. Current smokers were excluded (cessation <2 weeks). Steroid and NSAID use, smoking history, history of previous foregut surgery, and occurrence of positive intraoperative leak test were also collected. Statistical analysis was performed using IBM SPSS v23.0, with α=0.05.
Results: 212 patients (NC: N=187, C: N=25) were included in this study. Mean age was 47±7.3 years (NC:47±11.4, C:42±11.5 years), 81.8% were female. Our patients had a total complication rate (ulceration, stricture or gastritis) of 11.79%, with 3.30% developing marginal ulceration, 6.60% stricture, and 1.89% having both ulceration and stricture during the follow up period. The average time for marginal ulceration and stricture occurrence was 11 months and 3 months, respectively. None of the patients were diagnosed with gastritis. Logistic regression analysis (N=212) identified patients with a positive intraoperative leak test had increased complication rates (9.56 OR, CI [2.32 – 39.36]), p=0.002. Hyperlipidemia was also an independent predictor of complications (6.18 OR, CI [1.69 – 22.61]), p=0.006. Older age was protective (0.88 OR, CI [0.82 – 0.94]), p<0.001. Gender, race, preoperative BMI, diabetes, obstructive sleep apnea, gastroesophageal reflux disease, hypertension, steroid and NSAID use, and history of previous foregut surgery did not predict complications. Patients with a history of smoking had equivalent risk of never-smokers (p=0.169 cessation within 1 year, p=0.187 cessation >1 year).
Conclusions: Marginal ulceration and stricture are common complications after RYGB, with a variety of contributing factors. This study found that the best predictive factors for these complications were a positive intraoperative leak test, previous history of hyperlipidemia, and younger patients. Interestingly, smoking cessation showed a similar risk than non-smokers, and BMI and diabetes did not seem to contribute to the complication rates.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87087
Program Number: P602
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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