Background

Robotic Roux-en-Y gastric bypass (RYGB) is safe and effective as a metabolic and bariatric procedure, but it may lead to complications such as chronic marginal gastrojejunostomy (GJ) ulcers that might not heal despite medical and endosocopic therapies. These complications may include bleeding, obstruction, perforation, or all of the above We present the case of a 58 year old female with BMI of 19 and chronic marginal ulcers with bleeding and obstruction refractory to medical therapy and endoscopic dilation. She was consented for a robotic GJ revision after a multidisciplinary evaluation by a panel of experts.The operation was performed with the robotic platform without complications. The retrocolic antegastric RYGB anatomy was associated with chronic inflammation at the GJ anastomosis that required meticulous adhesiolysis. A new GJ anastomosis with intact blood supply was constructed after resection of the GJ with a redundant blind end of the Roux limb (candy cane). The patient had a favorable hospital course and outpatient follow up. Upper GI endoscopy at 4 years showing no complications from the revised GJ anastomosis and was associated with improved quality of life, weight, and nutrition status.Chronic GJ ulcers may be caused by technical factors, patient-related factors, or both. A revision of the RYGB may have to be performed with resection and reconstruction of the GJ when medical and endoscopic therapies fail. The robotic platform offers excellent ergonomic advantages for revisional metabolic and bariatric surgery, but surgical judgment takes precedence over the MIS approach.