Background

Marginal ulcers (MU) are possible complications following Roux-en-Y gastric bypass (RYGB). Our institution performs three different laparoscopic gastrojejunostomy (GJA) techniques. The aim of this study with 10-year data is to analyze the incidence of MU between 25-mm end-to-end anastomosis (EEA) stapler, linear stapler (LS), and hand-sewn (HS) GJA techniques.

Methods

A retrospective single-institutional review of patients who underwent esophagogastrojejunoscopy (EGJ) after RYGB were queried from 2010-2019. The type of GJA, complications, endoscopic interventions, smoking, NSAID use, steroid use, and PPI use were analyzed.

Results

A total of 2,683 RYGBs were performed, of which the GJA was created using EEA stapler 58.3%, linear stapler 32.9%, and handsewn 8.8% of the time. 12.4% had an EGJ (15.4% EEA, 8.1% linear, 8.1% HS). MU incidence was 6.7% (9.2% EEA, 3.3% linear, 3.4% HS). The rates of EGJ were significantly higher after EEA versus linear and handsewn anastomosis (p<0.05). Rates of MU were statistically significant after EEA stapler versus LS (p<0.05). The rate of NSAID use and smoking was found to be not statistically significant between EEA, LS, and HS.

Conclusions

A 25-mm EEA stapler used to create the GJA in RYGB increases the chances of having an EGJ and detecting marginal ulcers.