Background: Marginal ulcers (MU) are a well-known complication of laparoscopic roux-en-y gastric bypass (LRYGB), occurring in up to 10% of cases. MU usually respond to medical management, but failures do occur. Little is written concerning other therapeutic options. We present 10 cases of persistent or recurrent marginal ulcers managed with thoracoscopic vagotomy.
Methods: All patients undergoing LRYGB from 2001 to 2006 were entered into a prospective longitudinal database. MU were diagnosed endoscopically and treated with proton pump inhibitors. Patients with endoscopically-proven persistent or recurrent MU were given the option of either continued medical therapy or thoracoscopic vagotomy.
Results: Endoscopically documented MU occurred in 39 (4.6%) of 804 patients. MU occurred a mean of 7.4 months (range 4 to 43.2 months) following LRYGB. Of these 39 patients, 10 failed to improve or had MU recurrence. They subsequently underwent thoracoscopic vagotomy. Six of these patients required no further diagnostic evaluation. The remaining 4 patients had recurrent symptoms requiring endoscopy. A recurrent MU was identified in one of these patients.
Conclusion: We report 10 cases of documented persistent or recurrent MU refractory to medical management that underwent thoracoscopic vagotomy with a high rate of resolution. This technique provides a definitive surgical option for the treatment of persistent or recurrent MU that avoids revision of the anastomosis.