Background

Marginal ulceration is a major contributor to morbidity in patients that have undergone Roux en Y gastric bypass surgery.Objective: This study aims to evaluate a single institution experience managing perforated marginal ulcers and compare short term outcomes between non operative and operative management.

Methods

A retrospective analysis was performed including patients presenting to our emergency department with perforated marginal ulcer from July 2011 to December 2021. Patients with large volume pneumoperitoneum, free fluid, and peritonitis were more likely to undergo operative management with graham patch. Patients undergoing non operative management were admitted with nasogastric decompression and underwent upper gastrointestinal study on median hospital day three and resumed oral intake if this demonstrated no contrast extravasation.

Results

28 patients were included for analysis. 10 patients (36%) were treated with emergent operation and 18 patients (64%) treated with non operative management. 75% of patients were female. Mean age was 50.8 years. 32% of patients reported smoking and 25% reported NSAID use.Length of stay was lower overall for patients managed non-operatively with a median of 5 days versus a median 7 days length of stay for operative management. p=0.006 There were also fewer presentations to the ER and readmissions over the following year for patients managed non-operatively (median 0.5 presentations and median 0.85 readmissions) compared to operative management (median 1.5 presentations and median 1.4 readmissions). This was not statistically significant.

Conclusions

Non operative management is a safe and effective option for select patients presenting with perforated marginal ulcers.