10-Year outcomes of marginal ulcer formation and impact of gastrojejunostomy technique in Roux-en-Y gastric bypass

Background: Marginal ulcers (MUs) are potential complications following Roux-en-Y gastric bypass (RYGB) surgery. Our institution performs 3 different laparoscopic gastrojejunal anastomosis (GJA) techniques. The aim of this study was to analyze the incidence of MUs between 25-mm circular stapler (CS), linear stapler (LS), and hand-sewn (HS) GJA techniques using data collected over a 10-year period.

Methods: A retrospective single-institutional review of patients who underwent upper endoscopy after RYGB was queried (2010-2019). The type of GJA performed, complications, endoscopic interventions, smoking, and nonsteroidal anti-inflammatory drug (NSAID) use were analyzed.

Results: Overall, 2683 RYGBs were performed (1564 CS, 883 LS, and 236 HS) and an upper endoscopy was performed in 12.4% of these patients (15.4% of CS, 8.1% of LS, and 8.1% of HS patients). The incidence of MU was 6.7% (9.2% of CS, 3.3% of LS, 3.4% of HS patients). Rates of endoscopy were higher after CS versus LS and HS GJA, and incidence of MU was higher in the CS cohort versus LS and HS. Incidence of strictures was higher after CS GJA versus LS and HS, and revision of the GJA due to MU was higher following use of a CS versus LS and HS.

Conclusion: Comparing 3 common GJA techniques for RYGB, the incidence of upper endoscopy after RYGB was higher following CS GJA, and incidence of MU, stricture, and revisional surgery for MU after RYGB were high in the CS cohort.