Search

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., Competing Interests: Declarations. Conflict of Interest: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Preoperative diagnostic protocols vary worldwide, some prioritizing safety while others question routine procedures. Building on prior research, this study explores the impact of diverse preoperative findings on bariatric management and procedure selection., Methods: In a retrospective analysis of prospective data of over 1000 bariatric surgery patients from January 2017 to December 2022 undergoing primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG) were analyzed. Preoperative assessment included upper endoscopy, upper GI series, and esophageal manometry. Sonography data were excluded. The primary endpoint examined the influence of preoperative exams on procedure selection, the secondary endpoint evaluated their therapeutic impact., Results: 897 patients (741 RYGB, 156 SG) were included. All underwent upper endoscopy, revealing common findings such as type C gastritis and reflux esophagitis. Upper endoscopy prompted a therapeutic consequence in 216 patients (24.3%), resulting in a number needed to screen (NNS) of 4.1. Upper GI series and manometry were more frequently performed before LSG. Upper GI series detected hiatal hernias and motility disorders but did not result in any change of procedures. Esophageal manometry found pathologies in 37 (25.3%) patients rising to 41.5% if symptoms were present. Overall, 16 (1.8%) patients experienced a change in the planned procedure, with 14 changes prompted by preoperative findings and two by technical difficulties., Conclusion: We advise routine upper endoscopies for all patients undergoing LRYGB or LSG, while reserving upper GI series only for selected cases. Manometry should be exclusively performed on symptomatic patients undergoing LSG, ensuring a balanced and individualized preoperative assessment., Competing Interests: Declarations. Disclosure: Adisa Poljo, Jakob J. Reichl, Romano Schneider, Julian Süsstrunk, Jennifer M. Klasen, Lana Fourie, Adrian T. Billeter, Beat P. Müller, Ralph Peterli, Marko Kraljević have no conficts of interest or financial ties to disclose. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of Northwestern Switzerland (reference number: 2018/00356). Informed consent: Informed consent was obtained from all subjects involved in the study., (© 2024. The Author(s).)