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Laparoscopic management of a perforated ulcer at the gastrojejunal anastomosis after LGBP
Anastomotic ulcers (also known as ‘‘marginal’’ ulcers) develop as a complication of Roux-en-Y gastric bypass for treatment of obesity, they are almost always found to arise in the jejunal Roux limb directly abutting the gastrojejunal anastomosis. Marginal ulcers have been reported in 1–16% of patients after gastric bypass surgery, developing in both the early and late postoperative periods.
Recommended references:
1. Sapala JA, Wood MH, Sapala MA, Flake TM Jr. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg 1998;8:505–516.
2. Csendes A, Burgos AM, Altuve J, Bonacic S. Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity. Obes Surg 2009;19:135–138.
3. Patel RA, Brolin RE, Gandhi A. Revisional operations for marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2009;5:317–322.
4. St. Jean MR, Dunkle-Blatter SE, Petrick AT. Laparoscopic management of perforated marginal ulcer after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006;2:668.
5. Goitein D. Late perforation of the jejuno-jejunal anastomosis after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2005;13(6):880–882.
V Podelski, L Marx, J Marescaux
Surgical intervention
7 years ago
3193 views
63 likes
0 comments
05:30
Laparoscopic management of a perforated ulcer at the gastrojejunal anastomosis after LGBP
Anastomotic ulcers (also known as ‘‘marginal’’ ulcers) develop as a complication of Roux-en-Y gastric bypass for treatment of obesity, they are almost always found to arise in the jejunal Roux limb directly abutting the gastrojejunal anastomosis. Marginal ulcers have been reported in 1–16% of patients after gastric bypass surgery, developing in both the early and late postoperative periods.
Recommended references:
1. Sapala JA, Wood MH, Sapala MA, Flake TM Jr. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg 1998;8:505–516.
2. Csendes A, Burgos AM, Altuve J, Bonacic S. Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity. Obes Surg 2009;19:135–138.
3. Patel RA, Brolin RE, Gandhi A. Revisional operations for marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2009;5:317–322.
4. St. Jean MR, Dunkle-Blatter SE, Petrick AT. Laparoscopic management of perforated marginal ulcer after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006;2:668.
5. Goitein D. Late perforation of the jejuno-jejunal anastomosis after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2005;13(6):880–882.
Transumbilical single-access perforated gastric ulcer repair
Background: Single-access laparoscopy (SAL) can be proposed in patients presenting peritonitis both for diagnosis and treatment. This video shows a transumbilical SAL performed for perforated gastric ulcer.

Video: A 30 year-old woman with a body mass index of 22.9 kg/m2 was admitted to the emergency room for diffuse abdominal pain. Preoperative work-up showed a pneumoperitoneum, hence a SAL was proposed to the patient. The procedure was performed using a standard 11mm reusable trocar for a 10mm, standard length, 30-degree scope, and curved reusable instruments inserted transumbilically without trocars. The cavity exploration showed a perforated gastric ulcer at the anterior surface of the prepyloric area. A suture repair, omentoplasty and lavage of the cavity was performed.

Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 108 minutes and laparoscopic time 86 minutes. Final umbilical incision length was 15mm. The patient’s pain medication could be kept low and the patient was allowed to be discharged on the 5th postoperative day. After 6 months, the patient was well with no visible umbilical scar.

Conclusion: Transumbilical SAL can be proposed in selected patients for suspicion of perforated gastric ulcer, with the main advantage of cosmetic result.
G Dapri, J Himpens, GB Cadière
Surgical intervention
7 years ago
3841 views
50 likes
0 comments
05:17
Transumbilical single-access perforated gastric ulcer repair
Background: Single-access laparoscopy (SAL) can be proposed in patients presenting peritonitis both for diagnosis and treatment. This video shows a transumbilical SAL performed for perforated gastric ulcer.

Video: A 30 year-old woman with a body mass index of 22.9 kg/m2 was admitted to the emergency room for diffuse abdominal pain. Preoperative work-up showed a pneumoperitoneum, hence a SAL was proposed to the patient. The procedure was performed using a standard 11mm reusable trocar for a 10mm, standard length, 30-degree scope, and curved reusable instruments inserted transumbilically without trocars. The cavity exploration showed a perforated gastric ulcer at the anterior surface of the prepyloric area. A suture repair, omentoplasty and lavage of the cavity was performed.

Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 108 minutes and laparoscopic time 86 minutes. Final umbilical incision length was 15mm. The patient’s pain medication could be kept low and the patient was allowed to be discharged on the 5th postoperative day. After 6 months, the patient was well with no visible umbilical scar.

Conclusion: Transumbilical SAL can be proposed in selected patients for suspicion of perforated gastric ulcer, with the main advantage of cosmetic result.