Alicia M Bonanno, MD, Brandon Tieu, MD, Farah Husain, MD. Oregon Health and Science University
INTRODUCTION– Marginal ulcer is a common complication following Roux-en-Y gastric bypass with incidence rates between 4-16%. Most marginal ulcers resolve with medical management and lifestyle changes, but in the rare case of a non-healing marginal ulcer there are few treatment options. Revision of the gastrojejunal(GJ) anastomosis carries significant morbidity and mortality with complication rates ranging from 10-50%. Thoracoscopic truncal vagotomy(TTV) may be a safer alternative with decreased operative times. The purpose of this study is to evaluate the safety and effectiveness of TTV in comparison to GJ revision for treatment of recalcitrant marginal ulcers.
METHODS AND PROCEDURES– A retrospective chart review of patients who required surgical intervention for non-healing marginal ulcers was performed from 1st September 2012 to 1st September 2017. All underwent medical therapy along with lifestyle changes prior to intervention and had pre-operative EGD that demonstrated a recalcitrant marginal ulcer. Revision of the GJ anastomosis or TTV was performed. Data collected included operative time, ulcer recurrence, morbidity rate, and mortality rate. Statistical analysis was performed using T-test and Fischer’s Exact Test.
RESULTS– A total of fifteen patients were identified who underwent either GJ revision (n=8) or TTV (n=7). There were no 30-day mortalities in either group. Mean operative time was significantly lower in the TTV group in comparison to GJ revision (95.7±16 vs. 197.8±89 minutes respectively, p=0.0141). Recurrence of the ulcer was not significant between groups and occurred following 2 GJ revisions and 1 TTV. Overall complication rate was not significantly different with 88% in the GJ revision group and 57% in the TTV group. Complications included anastomotic leak (1 GJ), anastomotic stricture (2 GJ), aspiration (1 TTV), dysphagia (1 GJ and 3 TTV), and dumping syndrome (2 GJ).
CONCLUSIONS– Our results demonstrate that thoracoscopic vagotomy may be a better alternative with decreased operative times and similar effectiveness. However, further prospective observational studies with a larger patient population would be beneficial to evaluate complication rates and ulcer recurrence rates between groups.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87944
Program Number: P418
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster