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  • 1.
    Wennerlund, Jeff
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Strigård, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sundbom, Magnus
    Deptartment of Surgical Sciences, Uppsala University, Uppsala, Sweden..
    Acid-related complications after laparoscopic Roux-en-Y gastric bypass: risk factors and impact of proton pump inhibitors2020In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 16, no 5, p. 620-625Article in journal (Refereed)
    Abstract [en]

    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.

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