Re-operative strategies for addressing chronic marginal ulcers after gastric bypass have been scarcely described and mostly are reports of a case or small series of cases. The revisional strategies described are I) ulcer excision with revision of the gastrojejunostomy and gastric transection if needed, II) ulcer excision with pouch downsizing and redo of gastrojejunostomy, III) ulcer excision with resection of the ischemic Roux limb segment, and IV) ulcer excision and reversal. The possible adjuvant procedures includes I) proximal remnant gastrectomy (partial gastrectomy), and II) vagotomy.