The Incidence of Marginal Ulceration Following Laparoscopic Roux-En-Y Gastric Bypass using a 30 versus 90-Day Post-operative Proton Pump Inhibitor Regimen

Xian Kang, MD, FRCSC, Luis Zurita-Macias-Valadez, MD, Mohammad Aburahmah, MD, Dennis Hong, MD, Mehran Anvari, MB, BS, PhD, Margherita Cadeddu, MD, Nalin Amin, MD, Scott B Gmora, MD. McMaster University

Introduction:

In this study, we examine the differential impact of employing a 30 versus 90-day post-operative PPI regimen on the development of marginal ulceration following roux-en-y gastric bypass (RYGB). Marginal ulceration (MU) is one of the most common complications following RYGB surgery. Proton pump inhibitors (PPI) are commonly administered to decrease the incidence of marginal ulcer development by suppressing gastric acid secretion.

Methods:

A retrospective cohort design was employed to study all patients undergoing RYGB surgery at a single, high volume Bariatric Centre in Hamilton Ontario, Canada. Two years ago, the duration of post-op PPI administration was increased at our centre from 30 to 90 days. In this study, the incidence of marginal ulceration is compared between patients who received either 30 or 90 days of post-operative PPI therapy. Diagnosis of marginal ulceration was confirmed by upper endoscopy in patients presenting with epigastric pain and a clinical history suggestive of marginal ulceration. A Chi–square test of independence was performed to examine incidence of marginal ulceration and PPI duration.

Results:

A total of 1102 patients underwent RYGB at our centre between January 2009 and January 2013. No differences in baseline characteristics were observed between groups. Of the 1102 patients followed, 696 received 30 days PPI while 406 received 90 days PPI. The overall incidence of marginal ulceration in all patients was 8.8% over four years. The incidence of marginal ulceration following laparoscopic RYGB decreased significantly (p<0.05) among patients receiving PPI for 90 days (n=12, 3.0%) compared to those receiving PPI for 30 days (n=85, 11.8%).

Conclusion:

The incidence of marginal ulcer was significantly lower in the cohort who received 90 days of PPI in comparison to the cohort who received 30 days following laparoscopic roux-en-y gastric bypass surgery.