title: Surgical management and outcomes of patients with marginal ulcer after Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Marginal ulcers (MUs) are potentially complex complications after Roux-en-Y gastric bypass. Although most resolve with medical management, some require surgical intervention. Many surgical options exist, but there is no standardized approach, and few reports of outcomes have been documented in the literature. The objective of this study was to determine the outcomes of surgical management of marginal ulcers.
  
  
  METHODS
  Data from all patients who underwent surgical intervention between 2004 and 2012 for treatment of MU after previous Roux-en-Y gastric bypass were reviewed.
  
  
  RESULTS
  Twelve patients with MUs underwent reoperation. Nine patients had associated gastrogastric fistulae (75%). The median time to reoperation was 43 months. Ten patients underwent subtotal gastrectomy, of which 9 had a revision of the gastrojejunal anastomosis and 1 did not. One underwent total gastrectomy with esophagojejunal anastomosis for ulcer after previous revisional partial gastrectomy, and 1 patient underwent video-assisted thoracoscopic truncal vagotomy for persistent ulcer-related bleeding in the early postoperative period. Three patients (25%) experienced postoperative complications associated with revisional surgery requiring reoperation. At median follow-up time of 35 months, 7 patients (58%) had chronic abdominal pain, and 4 patients (33%) had intermittent diarrhea. Three patients (25%) were lost to recent follow-up. None had recurrence of MU.
  
  
  CONCLUSIONS
  Patients can undergo one of several available surgical interventions, including laparoscopic subtotal gastrectomy with gastrojejunostomy revision. Though this appears to offer definitive treatment of MU, its benefits must be weighed against the increased risk of significant postoperative complications and chronic symptoms related to revisional surgery.
authors: Department of Surgery, NYU School of Medicine, New York, New York. Electronic address: Edward.chau@nyumc.org.
authors: Edward
authors: E
authors: Chau
authors: Department of Surgery, NYU School of Medicine, New York, New York.
authors: Heekoung
authors: H
authors: Youn
authors: Department of Surgery, NYU School of Medicine, New York, New York.
authors: Christine J
authors: CJ
authors: Ren-Fielding
authors: Department of Surgery, NYU School of Medicine, New York, New York.
authors: George A
authors: GA
authors: Fielding
authors: Department of Surgery, NYU School of Medicine, New York, New York.
authors: Bradley F
authors: BF
authors: Schwack
authors: Department of Surgery, NYU School of Medicine, New York, New York.
authors: Marina S
authors: MS
authors: Kurian
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D010437:Peptic Ulcer / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Gastrogastric fistula; Marginal ulcer; Morbid obesity; Revision; Roux-en-Y gastric bypass; Subtotal gastrectomy