Abstract
With the growth of bariatric surgery and the inevitable need for conversion/revision to other weight loss procedures, there exists a clear need to identify those characteristics that can help to guide beneficent decision making. Among gastric bypass patients, marginal ulcers are a common complication and are thought to be predisposed by a number of factors, including smoking. To date, no study has focused on whether smoking status of a patient at the time of gastric bypass is related to later marginal ulcer formation and other complications.
A meta-analysis of prior studies was performed with the addition of new data to determine the correlation between common postoperative complications (marginal ulcers, nausea/vomiting, bleeding, stricture), need for reintervention, weight loss and patient smoking habits at the time of laparoscopic gastric bypass. Trends and Relative Risks among smokers, former smokers and never smokers were calculated using this data.
Results demonstrate that current smokers have a statistically significant higher incidence (within the first year after surgery) of marginal ulcers, overall postoperative complications, percent excess weight loss, need for reintervention and postop pain with nausea/vomiting as compared to never smokers and smokers who have undergone at least six weeks of smoking cessation prior to surgery. in this regard, never smokers and former smokers were nearly equivocal in outcomes.
The results of this study support current recommendations for smoking cessation among patients who are undergoing a laparoscopic gastric bypass whether as a primary procedure or as a revision surgery. This analysis supports at least 6-8 weeks of cessation which can provide significantly improved outcomes in gastric bypass patients, particularly in regards to initial postoperative complications and later marginal ulcer development.