Introduction: The (mini)-gastric bypass (MGB) procedure utilizing a loop gastroenterostomy is being promoted as a safer and equally effective alternative to Roux-en-Y gastric bypass (RYGB). However, recent reports suggest there are significant complications associated with MGB, many requiring ultimate revision to RYGB. We present a two-stage approach to the surgical management of a perforated marginal ulcer and bile reflux after MGB.

Methods: A 37 year old female with a chronic history of epigastric pain presented with acutely worsening abdominal pain and clinical peritonitis. Further history revealed that she had undergone a MGB procedure six years earlier with inadequate medical follow-up.

Results: The patient underwent emergent exploration and laparoscopic omental patch repair of a perforated marginal ulcer. Due to persistent bile reflux, she eventually underwent successful laparoscopic revision to RYGB.

Conclusion: This case highlights the surgical management of potential complications after nonstandard bariatric procedures such as MGB. Ultimate revision to RYGB is often required for definitive therapy.