More Anastomotic Ulcers, Less Dumping, and Equal Weight Loss in Long vs. Short Gastric Pouch in Laparoscopic Roux-en-Y Gastric Bypass.

Abstract

Background: Anastomotic ulcers (AU) at the gastroenterostomy are a common postoperative complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). Possible risk factors for ulcer formation include active smoking, the use of non-steroidal anti-inflammatory drugs, increased tension or ischemia at the anastomosis, or factors that increase the acid secretion of the gastric pouch. Therefore, a longer gastric pouch may increase risk of AU formation after LRYGB.

Methods: This study is a retrospective analysis of prospective collected data from patients undergoing LRYGB between 2009 and 2019 with a minimum follow-up of 2 years. In 2018, we changed the operative technique from short to long gastric pouch LRYGB. We analyzed AU formation, dumping syndrome, age, weight evolution, obesity-associated medical problems, and NSAID in two groups: long (LP-GP) vs. short pouch (SP-GP) LRYGB.

Results: A total of 1058 patients were included in the analysis (178 with LP-GP and 880 with SP-GP). A long gastric pouch significantly increased the rate of AU (LP-GP 12.4% vs. SP-GP 2.6%, p ≤ 0.01, OR 5.3). In contrast, the appearance of dumping syndrome improved in patients undergoing LP-GP (LP-GP 49% vs. SP-GP 60%, P ≤ 0.01, OR 1.5). However, no difference was observed between the groups in terms of weight loss in the first 2 years postoperative.

Conclusion: LRYGB with a long compared to a short gastric pouch increases the rate of AU while decreasing the appearance of dumping syndrome. These findings influence the postoperative course of patients undergoing LRYGB, particularly concerning prolonged proton pump inhibitor prophylaxis and a possible tailored surgical approach.