Background

Marginal ulcer is a common complication following laparoscopic Roux-en-Y gastric bypass operations for morbid obesity.

Methods

A retrospective chart review of patients who required surgical intervention for non-healing marginal ulcers or those presenting with perforated marginal ulcers were reviewed during the time period January 2013 through February 2019. In cases of recalcitrant marginal ulcers, persistent ulceration was present despite medical therapy and lifestyle changes. In cases where the patient presented with free perforation surgical intervention occurred at the time of presentation. Patients with recalcitrant marginal ulcers had preoperative EGD that demonstrated a recalcitrant marginal ulcer. Revision of the GJ anastomosis or resection of the marginal ulcer was done in all cases. Laparoscopic truncal vagotomy was performed following revision of the anastomosis or resection of the ulcer. We reviewed operative time, ulcer recurrence and complications in the 30 cases identified.

Results

30 patients were identified who underwent revision/resection following presentation with a recalcitrant or free perforation of a marginal ulcer. Every patient underwent simultaneous truncal vagotomy at the time of operation. Complete truncal vagotomy was confirmed on frozen section at the time of operation. There were no 30-day mortalities. All patients had surgical drains placed. There were no leaks. All patients underwent follow-up endoscopy 3-6 months after resection/vagotomy. There were no recurrent marginal ulcers discovered. Follow up of 5 months to 6 years reveals no recurrent ulcers. There were no reoperations or major complications.

Conclusions

Laparoscopic truncal vagotomy appears to be safe and effective in the treatment of marginal ulcers.