Introduction: Marginal ulcers are a feared late complication og gastric bypass. This is a video describing the minimally invasive approach to repair of a perforated marginal ulcer at the gastro-jejunostomy in a 49 year old patient. She underwent laparoscopic gastric bypass performed with EEA stapler, two years prior. She presented to the emergency department with several hours of epigastric pain. CXR showed free air under the right diaphragm.

Methods: In the operating room, a minimally invasive approach was completed using endoscopy and exploratory laparoscopy. A laparoscopic modified graham patch repair was performed.

Results: Post operatively a upper GI radiology study showed no leak. At that time, the patient was started on a bariatric soft diet.

Conclusion: At outpatient follow up visits, the patient is doing well.