Laparoscopic Treatment of Marginal Ulcer Perforation in a Patient with a Previous Roux-en Y Gastric Bypass

Abstract

Marginal ulcer formation can occur in 10% of morbidly obese patients treated with Roux-en Y gastric bypass. Marginal ulcer perforation is a significant complication, occurring in a minority of patients (1%). Treatment options include either omental patch repair or anastomotic revision. A 36-year-old female who previously underwent laparoscopic Roux-en Y gastric bypass surgery 1 year ago, presented with sudden onset of abdominal pain, tachycardia, fever, and leukocytosis. A CT scan of the abdomen showed free air with no obvious source. The patient was taken to the operating room for laparoscopic exploration. At laparoscopy, purulent fluid was present in the abdominal cavity and evacuated. There was an obvious marginal ulcer perforation that was less than 1.0 cm in diameter. An omental patch was secured to the ulcer site with 2.0 vicryl sutures. A drain was left in situ. Total operating room time was 40 minutes. There were no complications. Postoperatively, she did well and was discharged home on day 5 with oral antibiotics and a proton pump inhibitor. Patients with a known history of Roux-en Y gastric bypass for morbid obesity, who present with abdominal pain with free air, should be explored emergently through laparoscopy by MIS trained surgeons or a bariatric surgeon to avoid the morbidity of an unnecessary laparotomy. Marginal ulcer perforation can be treated with laparoscopic omental patch repair safely and effectively. Runtime of video: 5 mins 20 secs