Laparoscopic gastrojejunostomy revision: a novel approach to intractable marginal ulcer management.

Marginal ulcers are a known complication after Rouxen-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. This approach can threaten the integrity of the gastric pouch and potentially necessitate an esophageal anastomosis. We present a case study of an intractable marginal ulcer managed surgically through a nontraditional technique that aims to reduce such risk.