title: Seven cases of gastric perforation in Roux-en-Y gastric bypass patients: what lessons can we learn?
abstract: 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.
authors.affiliation: Western Bariatric institute, 645 N. Arlington Ave, STE 525, Reno, NV 89503, USA. dlim@westernsurgical.com
authors.forename: Kent C
authors.initials: KC
authors.lastname: Sasse
authors.forename: John
authors.initials: J
authors.lastname: Ganser
authors.forename: Mark
authors.initials: M
authors.lastname: Kozar
authors.forename: Robert W
authors.initials: RW
authors.lastname: Watson
authors.forename: Laurie
authors.initials: L
authors.lastname: McGinley
authors.forename: Dionne
authors.initials: D
authors.lastname: Lim
authors.forename: Melissa
authors.initials: M
authors.lastname: Weede
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Smith
authors.forename: Vicki
authors.initials: V
authors.lastname: Bovee
mesh_terms: 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
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal