title: Incidence of perforated gastrojejunal anastomotic ulcers after laparoscopic gastric bypass for morbid obesity and role of laparoscopy in their management.
abstract: BACKGROUND
  Laparoscopic Roux-en-Y gastric bypass (RYGB) is a well-established procedure to treat morbid obesity. Gastrojejunal anastomotic (GJA) ulcers can develop after surgery with subsequent perforation. Our aim was to evaluate the incidence, presentation and outcome of management of perforated GJA ulcer disease after laparoscopic RYGB.
  
  
  METHODS
  The database of all patients at the senior author's bariatric institutions was retrospectively reviewed. The results are presented as mean (range).
  
  
  RESULTS
  From April 2002 to April 2010, 1213 patients underwent laparoscopic RYGB, which included 1184 primary and 29 revision procedures. The operative mortality was .15%. Ten patients developed perforated GJA ulcers (.82%) at a mean of 13.5 (6-19) months. The patients who presented to bariatric surgeons (n = 5) were treated with laparoscopic closure and an omental patch, and those who presented to nonbariatric surgeons (n = 5) were treated with laparotomy. The morbidity and mortality rate was 30% and 10%, respectively, and the mean postoperative hospital stay for the survivors was 14 (5-44) days.
  
  
  CONCLUSIONS
  Perforated GJA ulcers can develop in 1 of 120 patients after laparoscopic RYGB and can be effectively managed by laparoscopic repair with an omental patch, if expertise is available.
authors.affiliation: Salford Royal Hospital, Salford, United Kingdom.
authors.forename: Ramya
authors.initials: R
authors.lastname: Kalaiselvan
authors.forename: Georgios
authors.initials: G
authors.lastname: Exarchos
authors.forename: Numan
authors.initials: N
authors.lastname: Hamza
authors.forename: Basil J
authors.initials: BJ
authors.lastname: Ammori
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology; D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007579:Jejunal Diseases / Q000209:etiology* / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010439:Peptic Ulcer Perforation / Q000209:etiology* / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome