An ulcer is defined as a local defect or excavation of the surface of an organ or tissue, produced by sloughing of necrotic inflammatory tissue.
Although the incidence of ulcers is rare in post-operative gastric bypass patients, the most commonly occurring form of ulcer is the marginal ulcer. Marginal ulceration is an ulcer at the margins of the gastrojejunostomy, mostly on the jejunal side.
Another type of ulcer that is reported by gastric bypass patients, although rarely,is the peptic ulcer. Peptic ulcers are sores in the stomach lining of the duodenum, which is the first part of the small intestine. Peptic ulcers are the result of damaged stomach walls, caused by acidity.
Factors Contributing to Ulcers After Gastric Bypass Operations
According to one study performed on 441 morbidly obese patients who underwent either laparotomic resectional gastric bypass (surgery where a portion of the stomach is removed from the body) or laparoscopic gastric bypass, 12.3 % of those who went through laparoscopic gastric bypass showed signs of marginal ulcer in its early stage compared to 4.15% that underwent laparotomic resectional gastric bypass . Thus, this study concluded that those patients in whom the excluded gastric segment was left in the stomach were more susceptible to early marginal ulcers after the gastric bypass operations.
Other factors present in gastric bypass patients that make them susceptible to having ulcers after their gastric bypass operations are having large gastric bypass pouches, having vertically oriented pouches, and having staple-line dehiscence or disruption.
The presence of vertically oriented pouches is interconnected with staple-line disruption, as a study shows that patients with vertical pouches had the highest incidence of staple-line disruption, which therefore led to ulceration.