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<article article-type="research-article" dtd-version="1.0" xml:lang="en" xmlns:mml="https://www.w3.org/1998/Math/MathML" xmlns:xlink="https://www.w3.org/1999/xlink" xmlns:xsi="https://www.w3.org/2001/XMLSchema-instance">
  <front>
    <journal-meta>
      <journal-title-group>
        <journal-title>Journal of Medical Insight</journal-title>
      </journal-title-group>
      <?Pub Caret -1?>
      <issn pub-type="epub">2373-6003</issn>
      <publisher>
        <publisher-name>JoMI</publisher-name>
        <publisher-loc>Boston, Massachusetts</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">25</article-id>
      <article-id pub-id-type="doi">10.24296/jomi/25</article-id>
      <article-categories>
        <subj-group>
          <subject>Research article</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Approach to Marginal Ulceration Following RYGB Surgery: Laparoscopic Excision of the Marginal Ulcer and Retrocolic, Retrogastric Rerouting of the Roux Limb with Truncal Vagotomy and Hiatal Hernia Repair</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name name-style="western">
            <surname>Pratt MD</surname>
            <given-names id="r1yWZtjeUTb">Janey Sue Pratt MD</given-names>
          </name>
          <xref ref-type="aff" rid="aff-1"/>
        </contrib>
      </contrib-group>
      <aff id="aff-1">
        <label id="Hyht1gnq">Massachusetts General Hospital</label>
      </aff>
      <pub-date pub-type="ppub">
        <year>2024</year>
      </pub-date>
      <volume>2024</volume>
      <issue>11</issue>
      <permissions>
        <copyright-statement>2017 Journal of Medical Insight</copyright-statement>
        <copyright-year>2017</copyright-year>
        <license xlink:href="https://jomi.com/license">
          <license-p>
            You may create an account, or sign in to gain temporary access for evaluation purposes.
                    To maintain access: please let your librarian know you would like a subscription or send us an email at subscribe@jomi.com and we will forward your feedback to your librarian.
            <uri xlink:href="https://jomi.com/license"/>
          </license-p>
        </license>
      </permissions>
      <self-uri content-type="html" xlink:href="https://jomi.com/article/25/approach-to-marginal-ulceration-following-rygb-surgery-laparoscopic-excision-of-the-marginal-ulcer-and-retrocolic-retrogastric-rerouting-of-the-roux-limb-with-truncal-vagotomy-and-hiatal-hernia-repair">Content is available at https://jomi.com/article/25/approach-to-marginal-ulceration-following-rygb-surgery-laparoscopic-excision-of-the-marginal-ulcer-and-retrocolic-retrogastric-rerouting-of-the-roux-limb-with-truncal-vagotomy-and-hiatal-hernia-repair</self-uri>
      <abstract>
        <p>Gastrogastric fistula is a rare complication following a Roux-en-Y gastric bypass procedure wherein there is a communication between the proximal gastric pouch and the distal gastric remnant. Patients typically present with nausea and vomiting, abdominal pain, intractable marginal ulcer, bleeding, reflux, poor weight loss, and weight regain. Etiologies include postoperative Roux-en-Y gastric bypass leaks, incomplete gastric division, marginal ulcers, distal obstruction, and erosion of a foreign body. Diagnosis is made through upper gastrointestinal contrast radiography or CT scan and endoscopy. Barium contrast radiography is particularly useful and is the preferred initial study method for the detection of staple-line dehiscence, which may be small and overlooked during endoscopy. Once identified, a gastrogastric fistula may be treated surgically with remnant gastrectomy or gastrojejunostomy revision. Here, we present a case of a female patient status post Roux-en-Y gastric bypass surgery who presented with abdominal pain. Upon endoscopy, she was noted to have an inflamed gastric pouch and a gastogastric fistula. A laparoscopic gastric bypass revision was done to divide the gastrogastric fistula and to separate the gastric pouch from the gastric remnant in order to alleviate the inflamed gastric pouch and prevent further ulcer formation.</p>
      </abstract>
      <kwd-group>
        <kwd>Laparoscopic</kwd>
        <kwd>SCORE</kwd>
        <kwd>Female</kwd>
        <kwd>Endoscopy</kwd>
        <kwd>Complication Management</kwd>
        <kwd>Elective</kwd>
        <kwd>Adult</kwd>
        <kwd>Advanced</kwd>
        <kwd>Adhesiolysis</kwd>
        <kwd>Intraoperative GI Endoscopy</kwd>
        <kwd>Anastomosis Techniques</kwd>
        <kwd>Specimen Retrieval</kwd>
        <kwd>Revision Surgery</kwd>
        <kwd>Rare Indication</kwd>
      </kwd-group>
    </article-meta>
  </front>
</article>