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Laparoscopic revision of transoral endoscopic vertical gastroplasty to Roux-en-Y gastric bypass
There are a number of endoscopic bariatric therapies, which have been proven to be safe and effective in the treatment of obesity [1]. The transoral endoscopic vertical gastroplasty (TOGA) is an endoscopic procedure in which flexible instruments are introduced through the mouth, passed to the stomach, and used to acquire tissue along the anterior and posterior stomach walls, fold the tissue, and staple it to create a restrictive pouch [2]. This procedure has been shown to be safe and produce up to 44.8% excess weight loss at one year [2,3].Laparoscopic revision of chronic marginal ulcer and bilateral truncal vagotomy
In accredited centers, bariatric surgery is performed with very low mortality, morbidity, and readmission rates [1–3]. However, a small number of bariatric patients develop postoperative complications such as marginal ulcers. Previous reports cite the incidence of marginal ulcer with significant variability, from .6% to 16% [4]. The etiology of marginal ulcers after a laparoscopic Roux-en-Y gastric bypass is a matter of debate. Many factors are believed to contribute to the development of marginal ulcers, such as smoking, ischemia, foreign body reaction, gastrogastric fistulas, large gastric pouches, and tension at the anastomosis [5–9].Laparoscopic revision of gastrojejunostomy and vagotomy for intractable marginal ulcer after revised gastric bypass
The incidence of marginal ulceration after gastric bypass has been reported with significant variability (1–16%) [1]. 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.
