title: Comparison of marginal ulcer rates between antecolic and retrocolic laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Marginal ulcer can be a serious complication after laparoscopic gastric bypass surgery. The aim of this study was to compare the rates of marginal ulcer between the antecolic and the retrocolic technique, in a large cohort of patients.
  
  
  METHODS
  Over a near 10-year period, 1,142 patients underwent laparoscopic gastric bypass surgery. The antecolic and the retrocolic technique were used in respectively 572 and 570 consecutive patients. All procedures were performed using a circular stapled gastrojejunostomy.
  
  
  RESULTS
  Patients were followed for 18 to 99 months (mean 48.8 months). During follow-up, 46 patients developed a marginal ulcer (4 %), 32 in the antecolic group (5.6 %) and 14 in the retrocolic group (2.5 %). Nineteen patients (3.3 %) in the antecolic group and eight patients in the retrocolic group (1.4 %) developed early marginal ulcer (i.e., within 3 months after surgery). The mean time to onset of anastomotic ulcer symptoms after surgery was 11 months (range 0.25-72). Forty-four patients were submitted to medical treatment, and 35 patients (79.5 %) had complete resolution of their symptoms.
  
  
  CONCLUSIONS
  Patients with an antecolic Roux limb develop significantly more marginal ulcers (p = 0.007) and early marginal ulcer (p = 0.033) than the patients with a retrocolic Roux limb. The antecolic technique seems to be a risk factor for appearance of marginal ulcer.
authors.affiliation: Service Chirurgie Générale et Digestive, Hôpital Bichat Claude Bernard, 46 Rue Henri Huchard, 75018, Paris, France, lara.parenti@me.com.
authors.forename: Lara
authors.initials: L
authors.lastname: Ribeiro-Parenti
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Arapis
authors.forename: Denis
authors.initials: D
authors.lastname: Chosidow
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Marmuse
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D010437:Peptic Ulcer / Q000209:etiology*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*
references.citation: Surg Obes Relat Dis. 2013 Sep-Oct;9(5):760-4
references.pmid: 22951079
references.citation: Surg Obes Relat Dis. 2007 Nov-Dec;3(6):619-22
references.pmid: 18023815
references.citation: Surg Endosc. 2005 Apr;19(4):519-24
references.pmid: 15742123
references.citation: Surg Endosc. 2009 Sep;23(9):2011-5
references.pmid: 19067070
references.citation: Obes Surg. 2005 Nov-Dec;15(10):1375-8
references.pmid: 16354514
references.citation: Surg Obes Relat Dis. 2007 Sep-Oct;3(5):508-14
references.pmid: 17686661
references.citation: Surg Obes Relat Dis. 2006 Jul-Aug;2(4):455-9
references.pmid: 16925380
references.citation: Surg Obes Relat Dis. 2014 Mar-Apr;10(2):229-34
references.pmid: 24462313
references.citation: Surg Obes Relat Dis. 2008 May-Jun;4(3):383-8
references.pmid: 17974495
references.citation: Surg Obes Relat Dis. 2006 Jul-Aug;2(4):460-3
references.pmid: 16925381
references.citation: Am J Gastroenterol. 1992 Sep;87(9):1165-9
references.pmid: 1519574
references.citation: Obes Surg. 2005 Jun-Jul;15(6):771-7
references.pmid: 15978145
references.citation: J Gastrointest Surg. 2006 Dec;10(10):1397-9
references.pmid: 17175460
references.citation: Obes Surg. 2005 Mar;15(3):342-5
references.pmid: 15826466
references.citation: Obes Surg. 2010 Jul;20(7):841-5
references.pmid: 20443151
references.citation: Surg Endosc. 2006 Jan;20(1):51-4
references.pmid: 16333541
references.citation: Obes Surg. 2005 Sep;15(8):1096-102
references.pmid: 16197778
references.citation: Surg Obes Relat Dis. 2006 Jan-Feb;2(1):11-6
references.pmid: 16925306
references.citation: Arq Gastroenterol. 2010 Apr-Jun;47(2):130-4
references.pmid: 20721455
references.citation: Am J Surg. 2002 Feb;183(2):117-23
references.pmid: 11918873
references.citation: Obes Surg. 2002 Oct;12(5):634-8
references.pmid: 12448383
references.citation: Obes Surg. 2008 Sep;18(9):1074-6
references.pmid: 18459016
references.citation: Obes Surg. 1998 Oct;8(5):505-16
references.pmid: 9819081
references.citation: J Laparoendosc Adv Surg Tech A. 2001 Dec;11(6):377-82
references.pmid: 11814129
references.citation: Obes Surg. 2014 Feb;24(2):299-309
references.pmid: 24234733
references.citation: Surg Endosc. 2008 Oct;22(10):2128-32
references.pmid: 18553197
references.citation: Obes Surg. 2009 Feb;19(2):135-138
references.pmid: 18581192
references.citation: Dig Dis Sci. 1994 Feb;39(2):315-20
references.pmid: 8313814
references.citation: J Am Coll Surg. 1997 Jul;185(1):1-7
references.pmid: 9208953
references.citation: Ann Surg. 1993 Jul;218(1):91-6
references.pmid: 8328834
references.citation: Obes Surg. 1996 Feb;6(1):44-49
references.pmid: 10731249
references.citation: Surg Endosc. 2007 Jul;21(7):1090-4
references.pmid: 17514403
references.citation: Surg Endosc. 2007 Jul;21(7):1216-20
references.pmid: 17404791
references.citation: Surg Obes Relat Dis. 2009 May-Jun;5(3):317-22
references.pmid: 19136312
references.citation: Endoscopy. 2011 Nov;43(11):950-4
references.pmid: 21997722
references.citation: Obes Surg. 1997 Dec;7(6):485-7; discussion 488
references.pmid: 9730505
references.citation: Am J Gastroenterol. 2006 Oct;101(10):2194-9
references.pmid: 17032183
references.citation: Obes Surg. 2011 Nov;21(11):1671-5
references.pmid: 21739350
references.citation: Obes Surg. 2007 Jul;17(7):889-93
references.pmid: 17894147
references.citation: Arch Surg. 1980 Apr;115(4):525-7
references.pmid: 7362464
references.citation: Am J Surg. 1976 Feb;131(2):162-8
references.pmid: 1251957
references.citation: Ann Surg. 2006 Feb;243(2):181-8
references.pmid: 16432350