MANAGEMENT OF MARGINAL ULCERS IN OBESE PATIENTS AFTER LAPAROSCOPIC GASTRIC BYPASS

Abstract

Marginal ulcer (MU) is a frequent late complication in patients after laparoscopic gastric bypass, occurring in 3-25% of patients. During the past 10 years, there has been a decrease in the rate of marginal ulcers, due to the improvement of surgical techniques and the widespread use of proton pump inhibitors II generation. According to the time of occurrence, marginal ulcers are classified into early (up to 30 days after surgery) and late (after 30 days). Aim. To improve the management of marginal ulcers in obese patients after laparoscopic gastric bypass. Materials and Methods. A retrospective analysis of 348 patients who underwent laparoscopic gastric bypass from 2011 to 2023 at the Department of General Surgery №2 of the National Medical University named after O.O. Bogomolets Patients aged 25 to 59 years with obesity according to IFSO criteria. The minimum observation period is 12 months. Results and Discussion. The study included 348 patients after laparoscopic gastric bypass. The majority are women 189 (54.3%). The average age was 44,81±9,79 years (25-59 years) and the average BMI was 45,43±4,77 kg/m2 (41.21-59.41). Marginal ulcers were diagnosed in 12 patients (3.4%). Symptoms were present in 10 patients (83.3%), the asymptomatic course was present in 2 patients (16.7%). Marginal ulcers were more often diagnosed in men 7/154 (4.54%). According to logistic regression, taking non-steroidal anti-inflammatory drugs OR = 3.62 (95%CI 1.04-12.6, p<0.001), diabetes type 2 OR = 2.62 (95%CI 0.75-9.09, p<0.001), chronic obstructive pulmonary diseases OR=2.25 (95%CI 1.19-4.28, p<0.001), affect the occurrence marginal ulcers. During 2011-2020, 8 (4.49%) cases of MU were detected among 178 treated patients, and during 2020-2023 only 4 (2.35%) among 170 patients. For the prevention of MU, a scheme was created: proton pump inhibitors II generation 20 mg twice a day for 6 months, instead of a scheme - proton pump inhibitors II generation 20 mg twice a day for 30 days after surgery. Conclusion. Risk factors for the occurrence of marginal ulcers are the use of nonsteroidal anti-inflammatory drugs, diabetes mellitus type 2, and chronic obstructive pulmonary disease. Modification of the management of obese patients after laparoscopic gastric bypass in the volume - the use of a regimen for the prevention of marginal ulcers: a proton pump inhibitor II generation 20 mg twice a day for 6 months, contributed to a decrease in the number of marginal ulcers.