Background

A complication following Laparoscopic Roux-en-Y gastric bypasses (LRYGB) is marginal ulcer (MU) formation. This is reported in up to 16% of patients that have undergone the operation. Between 85-95% of patients who present with MU post-LRYGB are likely to respond to medical therapy. However, there is a select group of patients that continue to suffer from symptomatic, non-healing MU despite appropriate medical management.Current approaches to surgical management include, surgical revision to resect the entire ulcer bed and recreate a new gastrojejunostomy. In 2020, Di Palma et al illustrates that the success rates of revisional surgeries are low, with a recurrence rate of MU as high as 57%. In our case report, we discuss the rare incidence in which both medical management and revisional surgery were unsuccessful. At which point the surgeon posed the patient with two options; reversal of LRYGB or truncal vagotomy to relieve the symptoms of the MU. The patient showed utmost reluctance to bypass-reversal, as her percent weight loss was substantial; BMI 57kg/M2 to 31kg/M2, in turn the patient agreed to truncal vagotomy.Although uncommon, vagotomy plays a role in treatment of non-healing MU. As bariatric surgeries continue to rise annually, we should expect to see an increase in the incidence of these rare non-healing MU. With increasing rates, clinicians should be familiar with vagotomy as an option for treating these rare cases. Our case report shares a success story of a patient with a non-healing MU refractory to medical management and revisional surgery.