Staple disruption and marginal ulceration in gastric bypass procedures for weight reduction

Background: Staple disruption is a frequent and serious complication of the segmentation procedures of gastric bypass surgery for weight reduction. Staple-line failure is frequently followed by weight gain and often marginal ulceration. Methods: We reviewed the literature and analysed our own series of 623 consecutively performed gastric bypass procedures for staple-line disruption and peptic ulceration. Gastric bypass procedures were broadly categorized by orientation of staple-line and location of the gastric pouch. Results: Vertical pouches created along the lesser curvature appear to have the highest incidence of staple-line disruption and peptic ulceration. The incidence of staple disruption and marginal ulceration is significantly diminished but not eliminated when gastric segments are completely divided. In our series no cases of staple disruption have been encountered since the gastric pouch has been separated from the excluded stomach by a limb of jejunum. Conclusions: The high incidence of staple disruption in gastric bypass procedures with vertically oriented, lesser curvature pouches is likely the result of the greater musculature, lower compliance and increased motility of this region of the stomach. The increased incidence of peptic ulceration with lesser curvature gastric pouches may be explained by the high concentration of parietal cells in this area of the stomach. Staple disruption in gastric bypass procedures can be effectively reduced by transection of gastric segments and possibly eliminated by separation of the pouch from the excluded stomach with a limb of jejunum.