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Laparoscopic conversion from mini gastric bypass/1 anastomosis gastric bypass to Roux-en-Y gastric bypass for perforated marginal ulcer: video case report
In 1997, Rutledge [1] introduced a new bariatric procedure consisting of a single anastomosis gastric bypass, which he named a mini gastric bypass (MGB).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.Laparoscopic gastrojejunostomy revision: a novel approach to intractable marginal ulcer management
Marginal ulcers are a known complication after Roux-en-Y gastric bypass, with a variable incidence of .6–16% [1,2]. Initial therapy involves elimination of the inciting risk factors [3] and medical management with a proton pump inhibitor and sucralfate therapy [4]. Although most marginal ulcers will heal with such treatment, approximately one third of patients will require operative intervention [5]. Surgery typically involves total revision of the gastrojejunostomy [6]. Revisional bariatric surgery, however, is technically difficult and has been associated with high morbidity and mortality rates.Laparoscopic revision of gastrojejunostomy revision with truncal vagotomy for persistent marginal ulcer after Roux-en-Y gastric bypass
The incidence of marginal ulcer formation after Roux-en-Y gastric bypass (RYGB) has been 1–16% [1]. Most patients will respond well to medical therapy and behavioral modifications; however, occasionally, surgery will be required for patients with persistent symptoms and ulceration. Revision of the gastrojejunostomy alone can lead to recurrent ulcer formation. Therefore, in cases in which the cause of the ulcer is unclear, adding a truncal vagotomy at the revision can help to prevent marginal ulcer recurrence.
