DOI: 10.1093/bjs/znad241.076 ISSN:

SP7.2 Marginal ulcers following one-anastomosis gastric bypass: a systematic review

Shiela Lee, Shreyas Supparamaniam, Chris Varghese, Kamal Mahawar
  • Surgery

Abstract

Aims

This systematic review aims to understand the incidence rates, associated factors, and management of MU following OAGB.

Methods

Four databases (PubMed, Cochrane CENTRAL, Embase) were used to systematically identify all studies on OAGB where authors had reported on MU. Data were collected on basic demographics, incidence rates, risk factors, and management of this condition.

Results

Thirty-two studies involving 8868 patients were analysed. The mean age and preoperative BMI were 40.9+/-4.5 years and 47.6+/-5.6 kg/m2 respectively. Approximately 72.0% (6388/8868) of patients were females. 20.6% (1825/8868) had preoperative gastroesophageal reflux disease. The mean operative time was 90.6+/-33.5 minutes. Only 14.1% (1252/8868) of patients were described to have been prescribed proton-pump inhibitors after surgery. The overall incidence of marginal ulcers was 2.59% (95% CI 1.89-3.52). Approximately 23.2% (53/228) of these presented within 12 months. 17.5% (40/228) were diagnosed with marginal ulcers after having endoscopy due to symptoms. Patients with a 45 mm sized gastrojejunal anastomosis (OR: 0.997, 95% CI 0.995-0.997, p=0.004) with double layer closure of stapler site (OR: 0.996, 95% CI: 0.994-0.998, p<0.001) were significantly less likely to develop a MU. Approximately, 88.1% (141/160) of patients were treated conservatively with proton-pump inhibitors (PPIs). The 30-day morbidity rate was 4.6% (411/8868). The 30-day morbidity rate including Clavien Dindo classification ≥ 3 was 1.3% (119/8868). Mortality rate was 0.1% (11/8868).

Conclusion

Marginal ulcer is an uncommon complication following one anastomosis gastric bypass. Majority of patients are treated conservatively with PPIs. This is the first systematic review in literature characterising MU after OAGB.

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