Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y Gastric Bypass: Case report

BMC Surgery

Antonio Nocito¹  Pierre-Alain Clavien¹  Marc Schiesser¹  Daniel C Steinemann² 

[1] Department of Visceral and Transplantation Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland;Department of Surgery, Cantonal Hospital Bruderholz, 4104 Bruderholz, Switzerland

关键词: obesity;    marginal ulcer;    anastomotic ulcer;    bariatric surgery;    Roux-en-Y-Gastric Bypass;   

Others  :  1123418
DOI  :  10.1186/1471-2482-11-33

 received in 2011-08-21, accepted in 2011-12-02,  发布年份 2011

【 摘 要 】

Background

Anastomotic or marginal ulcers occur in 0.6 to 16% of patients after laparoscopic Roux-en-Y-Gastric Bypass. Initial therapy aims at eliminating known risk factors including smoking, Helicobacter pylori infection, use of non-steroidal anti-inflammatory drugs and inhibition of gastric acid secretion. While this approach is successful in 68 to 88% of the cases, up to one third of patients need a subsequent surgical revision. However, marginal ulcers still recur in up to 10% of cases after revisional surgery, thus constituting a serious challenge for bariatric surgeons.

Case presentation

We herein report a case of an insidious marginal ulcer refractory to both medical therapy with high-dosed proton pump inhibitors and sucralfate as well as surgical therapy consisting of the lengthening of a short alimentary limb and later resection of the gastroenterostomy and construction of a new tension-free anastomosis. Only after gastrectomy by laparoscopic en-bloc resection of the gastrojejunostomy, the gastric pouch and resection of the gastric remnant with reconstruction by esophagojejunostomy the patient remained free of symptoms.

Conclusion

By laparoscopic resection of the entire gastric pouch and the gastric remnant the risk to leave a suboptimally vascularised or even ischemic pouch in situ was avoided. The esophagojejunostomy was then created in healthy, good vascularised tissue. In our case this novel approach was effective in the management of a refractory anastomotic ulcer and might represent a rescue option when simple revision of the gastrojejunostomy fails.

【 授权许可】

   
2011 Steinemann et al; licensee BioMed Central Ltd.

【 图 表 】

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