Seven cases of gastric perforation in Roux-en-Y gastric bypass patients: what lessons can we learn?
BACKGROUND
Patients undergoing Roux-en-Y gastric bypass for the resolution of morbid obesity have significant medical sequelae related to their weight. One of the most common comorbid conditions is joint pain requiring the use of non-steroidal anti-inflammatory medications (NSAIDs). In addition to NSAIDs, patients may engage in behaviors such as smoking and alcohol misuse that increase the risk of long-term postoperative complications to include gastric perforation.


METHODS
Data on 1,690 patients undergoing gastric bypass surgery were collected prospectively and reviewed retrospectively.


RESULTS
We identified seven patients who presented to an emergency room and subsequently required emergent surgical intervention for repair of gastric perforation. Six of the seven cases involved use or abuse of NSAIDs.


CONCLUSIONS
Important characteristics were identified including the use of NSAIDs, alcohol use, and non-compliance with routine long-term postoperative follow-up. Identifying those patients at high risk may decrease the incidence of this potentially life-threatening complication.
Sasse
Kent C
KC
Western Bariatric institute, 645 N. Arlington Ave, STE 525, Reno, NV 89503, USA. dlim@westernsurgical.com
Ganser
John
J
Kozar
Mark
M
Watson
Robert W
RW
McGinley
Laurie
L
Lim
Dionne
D
Weede
Melissa
M
Smith
Curtis J
CJ
Bovee
Vicki
V
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D015897:Comorbidity; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery; D010439:Peptic Ulcer Perforation / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology*; D011027:Pneumoperitoneum / Q000209:etiology; D013276:Stomach Ulcer / Q000139:chemically induced / Q000150:complications* / Q000453:epidemiology
D000894:Anti-Inflammatory Agents, Non-Steroidal