Marginal ulcers after laparoscopic Roux-en-Y gastric Bypass – Analysis of the amount of daily and lifetime smoking on postoperative risk

2019 
Abstract Introduction A common postoperative complication following laparoscopic Roux-en-Y gastric bypass (LRYGB) is the development of marginal ulcers (MUs) at the gastrojejunal anastomosis. Several risk factors, such as smoking, seem to have an impact on the development of MUs. Objective Very little is known about how much smoking increases the risk. We therefore reviewed our patients regarding their smoking behavior and the development of MUs after LRYGB. Setting Primary Care Hospital; University Hospital Methods This study included 249 patients who underwent LRYGB surgery between 2010 and 2015 with at least 2 years of follow-up at a single institution. This retrospective analysis focused on the development of marginal ulcers after LRYGB, the time of appearance, and possible risk factors. Results A total of 27 (10.8%) patients in this study developed MUs. The majority of MUs (66.7%) occurred within the first postoperative year. Smoking is an independent and statistically significant predictor of the development of MUs with a 4.6-fold greater risk (p=0.003). Light, moderate and heavy daily smokers have the same rate of MUs (17.4% vs. 17.1% vs. 17.9%, respectively). Light smokers with less than 10 cigarettes per day are at significantly increased risk for MUs compared to nonsmokers (17.4 vs. 4.2%, respectively; p=0.027). Former and current smokers are at comparable risks for MUs (13.3% vs. 17.5%, respectively; p=0.685). Conclusion The described incidence of 10.8% shows that marginal ulcers are one of the most important and frequent complications after LRYGB. Smoking at every intensity is associated with an extraordinary risk of MU formation after LRYGB and therefore, smoking cessation prior to bariatric surgery must be strongly recommended.
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