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Laparoscopic revision of gastrojejunostomy and vagotomy for intractable marginal ulcer after revised gastric bypass

  • Emanuele Lo Menzo
    Correspondence
    Correspondence: Emanuele Lo Menzo, M.D., Ph.D., Section of Bariatric and Minimally Invasive Surgery, Department of Surgery, University of Maryland School of Medicine, 22 South Greene Street, Room N4E27, Baltimore, MD 21201
    Affiliations
    Section of Bariatric and Minimally Invasive Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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  • Noel Stevens
    Affiliations
    Section of Bariatric and Minimally Invasive Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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  • Mark Kligman
    Affiliations
    Section of Bariatric and Minimally Invasive Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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      The incidence of marginal ulceration after gastric bypass has been reported with significant variability (1–16%) [
      • Patel R.A.
      • Brolin R.E.
      • Gandhi A.
      Revisional operations for marginal ulcer after Roux-en-Y gastric bypass.
      ]. Although its pathogenesis is unclear, several factors are associated with ulcer formation, including acid exposure, ischemia, foreign body, medications, and tobacco. In general, pharmacologic therapy is highly effective for ulcer healing, and surgical intervention is usually reserved for complications—typically bleeding or perforation. Rarely, surgical intervention is indicated for cases refractory to medical therapy.

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