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Surg Obes Relat Dis. 2020 Jan 20. pii: S1550-7289(20)30014-9. doi: 10.1016/j.soard.2020.01.005. [Epub ahead of print]

Acid-related complications after laparoscopic Roux-en-Y gastric bypass: risk factors and impact of proton pump inhibitors.

Author information

1
Deptartment of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden. Electronic address: Jeff.Wennerlund@regionvasterbotten.se.
2
Deptartment of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
3
Deptartment of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Abstract

BACKGROUND:

Laparoscopic Roux-en-Y (LRYGB) gastric bypass is an effective treatment for morbid obesity. Acid-related complications after LRYGB could be prevented by prophylactic proton pump inhibition (PPI).

OBJECTIVE:

To identify the effect of PPI prophylaxis on short-term, acid-related complications in a large cohort.

SETTING:

National Registry, Sweden.

METHODS:

A total of 37,301 patients who underwent LRYGB in Sweden from 2009 to 2014 were identified in the Scandinavian Obesity Surgery Registry. Patient-specific factors were cross matched with socioeconomic variables and information on PPI dispensation. A logistic regression model was used to analyze acid-related complications (e.g., marginal ulcer, stricture, and perforation) within 30 days and at 1 year postoperatively.

RESULTS:

PPI prophylaxis did not reduce the rate of acid-related complications. Instead, prolonged operation time (odds ratio [OR] 2.19 [1.53-3.13]) and immigrant background (OR 1.72 [1.17-2.53]) increased the risk of marginal ulcer within 30 days. At 1 year, medical treatment for diabetes (OR 1.75 [1.14-2.67]) and dyspepsia (OR 1.71 [1.06-2.75]), larger gastric pouch (OR 2.19 [1.528-3.248]), longer operation time (OR 1.67 [1.11-2.51]), smoking (OR 2.59 [1.77-3.78]), and immigrant background (OR 1.60 [1.08-2.36]) increased the risk for marginal ulcer, while older age (OR 2.20 [1.05-4.63]) predisposed for stricture. Inferior weight loss was associated with marginal ulcer at 1 year (OR 1.50 [1.04-2.15]).

CONCLUSION:

PPI prophylaxis did not reduce the risk for marginal ulcer and stricture. The risk for these complications was increased by several co-morbidities, smoking, immigrant background, and surgical factors. Routine use of PPI prophylaxis cannot be recommended, but smoking cessation and optimal surgery could be important.

KEYWORDS:

Gastric bypass; Marginal ulcer; Proton pump inhibition; Stricture

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