Background

Marginal ulcers (MU) are one of the most common postoperative complications following gastric bypass (GBP) surgeries occurring in approximately 1-23% of patients. Smoking and long-term NSAID use have been identified as common risk factors for predisposition of MU. With minimal research in this area, there are limited number of studies that have examined risk factors, complications, and overall health maintenance of patients with MU. This study aimed to identify common variables and analyze outcomes of patients requiring transthoracic vagotomy (TTV) for treatment of intractable ulcers. A retrospective chart review was conducted among patients (n=22) receiving care under one bariatric surgeon. Patients had undergone gastric bypass surgeries between 2003 and 2018 and developed MU that were refractory to first line of treatment. All patients underwent TTV procedures between 2009 to 2019. Variables including patient demographics, smoking history, prior NSAID use, and perioperative data were examined. Approximately 59% (n=13) of patients experienced successful resolution of MU without recurrence following a vagotomy procedure. There was overall improvement in symptoms including nausea and abdominal pain. As evidence shows that MU are a significant GBP postoperative complication, further understanding of patient risk factors and the pathophysiology may allow for preventative measures to be implemented in the future. Through extensive literature review with minimal findings, this retrospective study may have the potential to be one of the first that examined patients after GBP surgeries requiring TTV for treatment of intractable MU. Future investigations regarding the efficacy of TTV procedure for management of MU are warranted.