POUCH SIZE AND ITS ROLE IN MARGINAL ULCERATION FOLLOWING ROUX-EN-Y GASTRIC BYPASS SURGERY: A PROSPECTIVE STUDY OF ONE YEAR
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Keywords
Gastric Bypass, Marginal Ulceration, Pouch Size, Roux-en-Y, Ulcer Risk Factors
Abstract
Background: A well-known complication of RYGB is formation of marginal or stomal ulcers in the proximal Roux limb's jejunal mucosa. Larger pouches have more parietal cell mass, which produces acid, increasing the risk of ulcer development and acidity levels. The purpose of this study was to determine if pouch size had an effect on surgical outcomes in terms of formation of marginal ulcers.
Methods: This prospective observational study was carried out from January 2022 to January 2023. The patients undergoing Roux-en-Y gastric bypass (RYGB) were included in the study. Initial clinical examination and upper gastrointestinal endoscopy was used to confirm the diagnosis of marginal ulcer formation.A pouch size falling between the range of 1 to 4 cm was categorized as small pouch while those greater than 4cm contained large pouch sizes. The Chi square test was used to determine the association.
Results: A total of 135 patients performed Roux-en-Y gastric bypass surgery within the course of a year. Eighty-four patients (62%) underwent surgery using a small pouch (less than 4cm), while 51 patients (38%) underwent surgery using a large pouch (greater than 4cm). A total of 8 patients experienced marginal ulcer development over the one-year follow-up period.
Conclusion: This study concluded that although patients with larger pouches had a higher frequency of marginal ulcers, but the association was not statistically significant. Certain factors such as age, smoking status, and postoperative NSAID use, are also associated with the development of ulcers demonstrating the complex nature of ulcer pathophysiology.
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Mushtaq Ahmad
Assistant Professor, International Metabolic and Bariatric Weight loss surgical center, Afridi Medical Complex,Peshawar, Pakistan
Waqar Ahmad
Assistant Professor, Department of Anatomy, Khyber Girls Medical College,Peshawar,Pakistan
Maria Alamgir
Clinical Psychologist, International Metabolic and Bariatric Weight loss surgical center, Afridi Medical Complex,Peshawar, Pakistan
Abdul Haseeb Sahibzada
Research Officer, International Metabolic and Bariatric Weight loss surgical center, Afridi Medical Complex,Peshawar, Pakistan