Benjamin Clapp, MD. Providence Memorial Hospital.
This video demonstrates the combined laparoscopic and endoscopic management of perforated ulcers after gastric bypass. The first segment shows a perforated ulcer at the gastrojejunostomy and the laparoscopic management with an omental patch. The second segment shows the management of an antecolic antegastric bypass with a perforated prepyloric ulcer. The remnant stomach is accessed endoscopically for evaluation and biopsy. The last segment shows the management of a retrocolic, retrogastic bypass with a perforated prepyloric ulcer, also with endoscopic evaluation of the remnant stomach. The main technical points of this video are how to perform laparoscopic omental patches and how to simply access the remnant stomach, regardless of the technique used to perform the original gastric bypass.