Background

Despite advances, factors influencing the incidence of early marginal ulceration (MU) at the gastrojejunal anastomosis following Roux-en-Y Gastric Bypass (RYGB) remain poorly understood.

Methods

A prospectively maintained, single-institution database was queried to identify adults undergoing primary RYGB. Cohorts were stratified by presence of early dehydration (ED) – defined by need for outpatient intravenous fluid resuscitation within 30 days postoperatively. Early MU was diagnosed on endoscopy within 90 days. Bivariate analyses were performed between cohorts. Unadjusted time-to-event analyses were performed using the Kaplan-Meier (KM) method. Logistic regression modeling adjusting for demographics, comorbid conditions, and operative factors was utilized to evaluate independent predictors of early MU.

Results

Of 616 patients who underwent RYGB, 38 (6.2%) required outpatient fluid resuscitation for ED. Mean age was 44.9 (SD 11.2) and mean BMI was 47.3 (SD 8.1). ED patients were more likely to be female (94.6% vs 79.1%, p = 0.005). No differences were observed in age, comorbid conditions, smoking status, or gastrojejunal anastomotic technique among cohorts. Median length-of-stay was significantly longer for ED patients (2 days [IQR: 2-3] vs 2 days [IQR: 1-2], p = 0.04). ED patients were more likely to develop early MU (21.4% vs 4.6%, p<0.001), and demonstrated decreased overall MU free survival (Figure). After risk-adjustment, ED was independently associated with increased odds of early MU (OR 5.77, 95% CI: 2.56-13.0).

Conclusions

Patients who experience ED following RYGB are at 5-fold increased adjusted risk of developing MU within 90 days. The causative factors involved in this association require further study.