Advertisement

Laparoscopic revision of chronic marginal ulcer and bilateral truncal vagotomy

Published:October 16, 2015DOI:https://doi.org/10.1016/j.soard.2015.10.075
      In accredited centers, bariatric surgery is performed with very low mortality, morbidity, and readmission rates [
      • El Chaar M.
      • Claros L.
      • Ezeji G.C.
      • Miletics M.
      • Stoltzfus J.
      Improving outcome of bariatric surgery: best practices in an accredited surgical center.
      ,
      • Flum D.R.
      • Belle S.H.
      • King W.C.
      • et al.
      Perioperative safety in the longitudinal assessment of bariatric surgery.
      ,
      • Nguyen N.T.
      • Slone J.A.
      • Nguyen X.M.
      • et al.
      A prospective randomized trial of laparoscopic gastric bypass versus laparoscopic adjustable gastric banding for the treatment of morbid obesity: outcomes, quality of life, and costs.
      ]. However, a small number of bariatric patients develop postoperative complications such as marginal ulcers. Previous reports cite the incidence of marginal ulcer with significant variability, from .6% to 16% [
      • Patel R.A.
      • Brolin R.E.
      • Gandhi A.
      Revisional operations for marginal ulcer after Roux-en-Y gastric bypass.
      ]. The etiology of marginal ulcers after a laparoscopic Roux-en-Y gastric bypass is a matter of debate. Many factors are believed to contribute to the development of marginal ulcers, such as smoking, ischemia, foreign body reaction, gastrogastric fistulas, large gastric pouches, and tension at the anastomosis [
      • Lo Menzo E.
      • Stevens N.
      • Kligman M.
      Laparoscopic revision of gastrojejunostomy and vagotomy for intractable marginal ulcer after revised gastric bypass.
      ,
      • Azagury D.E.
      • Abu Dayyeh B.K.
      • Greenwalt I.T.
      • Thompson C.C.
      Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes.
      ,
      • Rasnussen J.J.
      • Fuller W.
      Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients.
      ,
      • Moon R.
      • Teixeira A.
      • Goldbach M.
      • Jawad M.
      Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center.
      ,

      Chau E., Heekoung Y., Ren-Fielding C., et al. Surgical management and outcomes of patients with marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis. Epub 2014 Dec 19.

      ].

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • El Chaar M.
        • Claros L.
        • Ezeji G.C.
        • Miletics M.
        • Stoltzfus J.
        Improving outcome of bariatric surgery: best practices in an accredited surgical center.
        Obes Surg. 2014; 24: 1057-1063
        • Flum D.R.
        • Belle S.H.
        • King W.C.
        • et al.
        Perioperative safety in the longitudinal assessment of bariatric surgery.
        N Engl J Med. 2009; 361: 445-454
        • Nguyen N.T.
        • Slone J.A.
        • Nguyen X.M.
        • et al.
        A prospective randomized trial of laparoscopic gastric bypass versus laparoscopic adjustable gastric banding for the treatment of morbid obesity: outcomes, quality of life, and costs.
        Ann Surg. 2009; 250: 631-641
        • Patel R.A.
        • Brolin R.E.
        • Gandhi A.
        Revisional operations for marginal ulcer after Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2009; 5: 317-322
        • Lo Menzo E.
        • Stevens N.
        • Kligman M.
        Laparoscopic revision of gastrojejunostomy and vagotomy for intractable marginal ulcer after revised gastric bypass.
        Surg Obes Relat Dis. 2011; 7: 656-658
        • Azagury D.E.
        • Abu Dayyeh B.K.
        • Greenwalt I.T.
        • Thompson C.C.
        Marginal ulceration after Roux-en-Y gastric bypass surgery: characteristics, risk factors, treatment, and outcomes.
        Endoscopy. 2011; 43: 950-954
        • Rasnussen J.J.
        • Fuller W.
        Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients.
        Surg Endosc. 2007; 21: 1090-1094
        • Moon R.
        • Teixeira A.
        • Goldbach M.
        • Jawad M.
        Management and treatment outcomes of marginal ulcers after Roux-en-Y gastric bypass at a single high volume bariatric center.
        Surg Obes Relat Dis. 2014; 10: 229-234
      1. Chau E., Heekoung Y., Ren-Fielding C., et al. Surgical management and outcomes of patients with marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis. Epub 2014 Dec 19.

        • Datta T.
        • Steele K.
        • Schweitzer M.
        Laparoscopic revision of gastrojejunostomy revision with truncal vagotomy for persistent marginal ulcer after Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2010; 6: 561-562
        • Lee Y.K.
        • McBride C.
        • Shostrom V.
        • et al.
        Surgical technique affects the incidence of marginal ulceration after Roux-en-Y gastric bypass.
        Surg Sci. 2013; 4: 1-7
        • Hunter J.
        • Stahl R.D.
        • Kakade M.
        • Breitman I.
        • Grams J.
        • Clements R.H.
        Effectiveness of thoracoscopic truncal vagotomy in the treatment of marginal ulcers after laparoscopic Roux-en-Y gastric bypass.
        Am Surg. 2012; 78: 663-668