Background

Early marginal ulcer (MU), occurring within 30-days of operation, is a rare event following Roux-en-Y gastric bypass (RYGB); however, recent data suggests an increased MU incidence after sleeve gastrectomy (SG) to RYGB conversion (SG-RYGB) compared to primary RYGB (p-RYGB). We hypothesized that early MU would be increased in VSG-RYGB compared to p-RYGB.

Methods

All 379,822 records from the 2020 and 2021 MBSAQIP public use files were examined. A total of 131,526 RYGB cases were extracted and, after excluding pediatric cases, non-binary gender, missing BMI data, missing operative time, and conversions other than SG-RYGB, 102,992 were included in analysis. Both p-RYGB & SG-RYGB patient characteristics, case information, and postoperative outcomes were compared. A diagnosis of early MU was modeled using sleeve conversion status and other relevant risk factors with a rare event logistic regression.

Results

Early MU occurred in 223 of 86,477 (0.3%) p-RYGB cases compared to 66 of 16,515 (0.4%) SG-RYGB p=0.0016). Conversion to SG remained a significant risk factor for early MU in a multivariable rare event logistic regression (OR 1.42 (1.05,1.93) p=0.025). Other risk factors included black race (p<.0001), insulin-dependent diabetes (p=0.020), history of cardiac catheterization (p=0.004), history of deep vein thrombosis (DVT) (p=0.055), and active immunosuppression therapy (p=0.003) (Table 1).

Conclusions

While early MU remains a rare event following RYGB, SG-RYGB patients are 42% more likely to experience early MU over their p-RYGB counterparts. As MU occurred at higher rates in SG-RYGB, careful attention to marginal ulcer prevention should be exercised in this population.