Studies show that ulcers are a well-recognized complication that result from gastric bypass procedures. But the type of ulcer that results from gastric bypass operations depends on the type of operative method that is employed for the gastric bypass.
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.
Quote: “Introduction of gastric bypass as treatment for morbid obesity in 1966 caused concern over its ulcerogenic potential as an antral exclusion procedure. However, in only 20 of our 653 patients has marginal ulceration developed.”
Source: Kenneth J. Printen, MD; David Scott; Edward E. Mason, MD; Stomach Ulcers After Gastric Bypass
Arch Surg. 1980;115(4):525-527.
Quote: “Ulcers in the GI tract are unusual after gastric bypass surgery. The most common place for ulceration is in the small intestines right after the hook-up to the small stomach pouch. Ulcers can occur in the duodenum and defunctionalized stomach as well. Ulcers are more common if patients smoke or take anti-inflammatory medication.”
Source: Dr. Alan Wittgrove; Inherent Benefits and Advantages of the Bariatric Surgeries
Wittgrove Bariartric Center; www.lapbypass.com
Sapala, James A., Andrew Sapala, Thomas M Flake M. Flake, and Michael H. Wood. “Marginal Ulcer After Gastric Bypass: A Prospective 3-Year Study of 173 Patients.” OBESITY SURGERY Volume 8.5: 505-16. Print.
Csendes, Attila, Ana Maria Burgos, Juan Altuve, and Santiago Bonacic. “Incidence of Marginal Ulcer 1 Month and 1 to 2 Years After Gastric Bypass: A Prospective Consecutive Endoscopic Evaluation of 442 Patients with Morbid Obesity.” Obesity Surgery 19.2 (2009): 135-38. Print.
“Marginal Ulcer – Definition of Marginal Ulcer in the Medical Dictionary – by the Free Online Medical Dictionary, Thesaurus and Encyclopedia..” Medical Dictionary. Farlex, n.d. Web. 5 Dec. 2010. http://medical-dictionary.thefreedictionary.com/marginal+ulcer.
Tercero MD, Francisco M., and Kelvin D. Higa MD. “Perforated Marginal Ulcer After Gastric Bypass (PerforatedMU).” ClinicalTrials.gov (2010). Web. 5 Dec. 2010. http://clinicaltrials.gov/ct2/show/NCT01041196.
“Peptic Ulcer.” National Library of Medicine – National Institutes of Health. Web. 05 Dec. 2010. http://www.nlm.nih.gov/medlineplus/pepticulcer.html.
Jordan, J. H., M. P. Hocking, W. R. Rout, and E. R. Woodward. “Marginal Ulcer Following Gastric Bypass for Morbid Obesity.” American Surgery 57.5 (1991): 286-88. Print.
Capella, J. F., and R. F. Capella. “Staple Disruption and Marginal Ulceration in Gastric Bypass Procedures for Weight Reduction.” Obesity Surgery Journal 6.1 (1996): 44-49. PubMed.go. U.S. National Library of Medicine. Web. 05 Dec. 2010. http://www.ncbi.nlm.nih.gov/pubmed/10731249?dopt=Abstract.