Background

Although the safety and efficacy of the Roux-en-Y Gastric Bypass (RYGB) in patients with obesity is well established, marginal ulceration (MU) remains a challenging complication. The impact of gastrojejunostomy (GJ) technique on rates of MU is poorly understood.

Methods

Consecutive adults undergoing primary laparoscopic RYGB were selected from a single institution database. MU was diagnosed on endoscopy or reoperation. Patients were stratified by GJ technique as stapled end-to-end (EEA) or linear stapled/handsewn (LS). MU free survival was evaluated using the Kaplan-Meier (KM) method. Cox proportional-hazards models were developed to assess the association between GJ technique and overall risk of MU adjusting for patient and operative factors.

Results

Among 675 patients who underwent RYGB, 74.7% utilized an EEA technique, and 25.3% LS. At the time of operation, mean age was 44.7 years, 81.5% were female, and mean BMI was 47.1 (SD 8.0). No differences were noted in patient characteristics among cohorts, including previous smoking history (p=0.46). No differences were noted in 30-day rates of readmission, emergency room visit, or overall morbidity (p>0.08). Overall observed MU rate was 17.9% for EEA and 10.5% for LS (p=0.024) with a mean overall follow up of 405 days. On KM analysis, GJ technique was not associated with a difference in MU free survival (Figure). However, Cox modeling revealed a decreased adjusted risk of MU for LS vs EEA: HR 0.57 [95%CI: 0.34-0.97].

Conclusions

A linear stapled GJ technique is associated with decreased adjusted risk of MU development in patients with obesity undergoing RYGB.