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Gastric Remnant Perforation after Roux-en-Y Gastric Bypass
recommendations. If there is an acute perforation with a small 2. Iranmanesh P, Manisundaran NV, Bajwa KS, et al. Management of
defect, the closure after biopsy is usually easy, performing a safe acute gastric remnant complications after Roux-en-Y gastric bypass:
and short laparoscopic procedure. Besides, it is recommendable a single-center case series. Obes Surg 2020;30(7):2637–2641. DOI:
to enable a gastric remnant access in the same surgery. It is also 10.1007/s11695-020-04537-w. Available from: https://pubmed.ncbi.
nlm.nih.gov/32162207/.
recommendable to perform a selective vagotomy to reduce the 3. Iskandar ME, Chory FM, Goodman ER, et al. Diagnosis and management of
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acid production. Gastric resection is sometimes executed in the perforated duodenal ulcers following Roux-En-Y gastric bypass: a report
second stage or when there is a large perforation or ischemia of two cases and a review of the literature. Case Rep Surg 2015;2015:1–4.
2
of the gastric remnant. Resecting the excluded stomach may DOI: 10.1155/2015/353468. Available from: https://pubmed.ncbi.nlm.nih.
decrease the gastric acid production and avoid the formation of gov/pmc/articles/PMC4408622/?report=abstract.
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gastrogastric fistula. However, resecting the stomach implies short- 4. Ovaere S, Tse WHW, Schipper EE, et al. Perforation of the
term complications such as bleeding of omental vessels, necrosis gastric remnant in a patient post-Roux-en-Y gastric bypass. BMJ
of omental fat with abscess formation, or duodenal stump leakage. Case Rep [Internet]. 2016;2016. DOI: 10.1136/bcr-2015-213862.
Other complications such as bacterial overgrowth and vitamin B12 Available from: https://pubmed.ncbi.nlm.nih.gov/pmc/articles/
PMC4785498/?report=abstract.
deficiency have also been described. 3,10 5. Dai L, Shah MM, Rosenblatt S. Perforated gastric remnant ulcer after
Regarding discharge and follow-up, guidelines recommend laparoscopic gastric bypass. BMJ Case Rep 2018;2018. DOI: 10.1136/
H. pylori eradication when tests were positive, and recommend bcr-2017-222190. Available from: https://pubmed.ncbi.nlm.nih.
1-month treatment with PPI. 1,12 gov/29622702/.
6. Bjorkman DJ, Alexander JR, Simons MA. Perforated duodenal ulcer
after gastric bypass surgery. Am J Gastroenterol 1989;84(2):170–172.
conclusion 7. Tornese S, Aiolfi A, Bonitta G, et al. Remnant gastric cancer after
Bariatric and general surgeons managing RYGBP patients should Roux-en-Y gastric bypass: narrative review of the literature. Obes Surg
not overlook gastric remnant complications in their differential 2019;29(8):2609–2613. DOI: 10.1007/s11695-019-03892-7. Available
diagnosis of abdominal pain. Gastric remnant perforation should from: https://pubmed.ncbi.nlm.nih.gov/31001760/.
be taken into account if a bariatric patient presents with severe, 8. Cleator LGM, Rae A, Birmingham CL, et al. Ulcerogenesis following
epigastric abdominal pain without important radiological findings. gastric procedures for obesity Obes Surg 1996;6(3):260–261.
Risk factors are not clear, but H. pylori eradication is recommended. DOI: 10.1381/096089296765556881. Available from: https://pubmed.
ncbi.nlm.nih.gov/10729870/.
Laparoscopic exploration should be performed urgently because 9. Csendes A, Burgos AM, Smok G, et al. Endoscopic and histologic
the operation time interval once the perforation has occurred is an findings of the foregut in 426 patients with morbid obesity. Obes
important predictor for morbidity and mortality. Defect closure or Surg 2007;17(1):28–34. DOI: 10.1007/s11695-007-9002-9. Available
gastric remnant resection may be performed without any general from: https://pubmed.ncbi.nlm.nih.gov/17355765/.
recommendations, but biopsies should be taken. 10. Gypen BJ, Hubens GJA, Hartman V, et al. Perforated duodenal ulcer
after laparoscopic gastric bypass. Obes Surg 2008;18(12):1644–1646.
DOI: 10.1007/s11695-008-9530-y. Available from: https://pubmed.
orcid ncbi.nlm.nih.gov/18443886/.
Carlota Tuero https://orcid.org/0000-0001-8577-5603 11. Pohl D, Schmutz G, Plitzko G, et al. Perforated duodenal ulcers after
Roux-Y Gastric Bypass. Am J Emerg Med 2018;36(8):1525.e1–1525.e3.
DOI: 10.1016/j.ajem.2018.04.057. Available from: https://pubmed.
references ncbi.nlm.nih.gov/29716802/.
1. Plitzko G, Schmutz G, Kröll D, et al. Ulcer disease in the excluded 12. Satoh K, Yoshino J, Akamatsu T, et al. Evidence-based clinical practice
segments after Roux-en-Y gastric bypass: a current review of the guidelines for peptic ulcer disease. J Gastroenterol 2016;51(3):177–194.
literature. Obes Surg 2020;31(3):1280–1289. DOI: 10.1007/s11695-020- DOI: 10.1007/s00535-016-1166-4. Available from: https://pubmed.
05123-w. ncbi.nlm.nih.gov/26879862/.

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