Background

Ulceration at the gastrojejunostomy margins is a late bariatric surgery complication, occurring in 0.6 to 16% of Roux-en-Y gastric bypass (RYGB) patients. Most marginal ulcers respond to medical treatment; however, a perforated marginal ulcer is a serious complication requiring surgical intervention. We compare two methods of surgical repair: the most commonly performed procedure, suturing of ulcer with or without omental (Graham) patch versus revision gastrojejunostomy (RG).

Methods

A retrospective chart review from November 2, 2006 through December 1, 2019 identified RYGB patients undergoing surgical repair for a perforated ulcer at St. Vincent Carmel Bariatrics. 135 bariatric patients were identified: 72 treated by suturing with or without Graham patch (SGP) and 63 by RG. Outcomes, including length of stay, leaks, readmissions, and reoperations were compared.

Results

Patients were primarily female (76.3%) and Caucasian (97.8%), 49+-12 years old, and 201.4+-59.0 lbs. Most had laparoscopic RYGBs (97%). There were no demographic differences between groups. 11.1% of RG patients experienced ulcer recurrence, compared to 37.5% of SGP patients (p<.01). There were no significant differences between groups in time to perforation (28.7 vs. 30.6 months for RG and SGP groups, respectively) length of stay (4.79 vs. 6.67 days), leaks (1.6% vs. 1.4%), readmissions (4.8% vs. 4.2%), or reoperations (1.6% vs 5.6%).

Conclusions

Patients who develop perforated marginal ulcers after RYGB can be safely and effectively treated by revision gastrojejunostomy with a lower likelihood of recurrence. Short term results were comparable to suturing with or without an omental patch.