title: Omental patch repair effectively treats perforated marginal ulcer following Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Marginal ulcer formation remains a significant complication of Roux-en-Y gastric bypass (RYGB). Up to 1 % of all RYGB patients will develop free perforation of a marginal ulcer. Classically, this complication has required anastomotic revision; however, this approach is associated with significant morbidity. Several small series have suggested that omental patch repair may be effective. The aim of this study was to examine the management of perforated marginal ulcers following RYGB.
  
  
  METHODS
  All patients who underwent operative intervention for perforated ulcers between 2003 and 2011 were reviewed. Those with a history of RYGB with perforation of a marginal ulcer were included in the analysis. Data collected included operative approach, operative time, blood loss, length of hospital stay, complications, smoking history, and steroid or NSAID use.
  
  
  RESULTS
  From January 2003 to December 2011, a total of 1,760 patients underwent RYGB at our institution. Eighteen (0.85 %) developed perforation of a marginal ulcer. Three patients' original procedure was performed at another institution. Eight patients (44 %) had at least one risk factor for ulcer formation. Treatment included omental patch repair (laparoscopic, n = 7; open, n = 9) or anastomotic revision (n = 2). Compared to anastomotic revision, omental patch repair had shorter OR time (101 ± 57 vs. 138 ± 2 min), decreased estimated blood loss (70 ± 72 vs. 250 ± 71 mL), and shorter total length of stay (5.6 ± 1.4 vs. 11.0 ± 5.7 days).
  
  
  CONCLUSIONS
  Perforated marginal ulcer represents a significant complication of RYGB. Patients should be educated to reduce risk factors for perforation, as prolonged proton pump inhibitor therapy may not prevent this complication in a patient with even just one risk factor. In our sample population we found laparoscopic or open omental patch repair to be a safe and effective treatment for this condition and it was associated with decreased operative time, blood loss, and length of stay.
authors.affiliation: Department of Surgery, The Ohio State University, 548 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210, USA. mark.wendling@osumc.edu
authors.forename: Mark R
authors.initials: MR
authors.lastname: Wendling
authors.forename: John G
authors.initials: JG
authors.lastname: Linn
authors.forename: Kara M
authors.initials: KM
authors.lastname: Keplinger
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Mikami
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Perry
authors.forename: W Scott
authors.initials: WS
authors.lastname: Melvin
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Needleman
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009852:Omentum / Q000601:surgery; D010439:Peptic Ulcer Perforation / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies