Post gastric bypass hypoglycemia (PGBH) is a potential complication of RYGB . It usually presents months to years after surgery and treatment follows a systematic approach with initial focus on diet, followed by pharmacological therapy, and finally surgery as a last resort. We present a patient with PGBH in the setting of failed medical therapy, . We describe the laparoscopic surgical technique for reversal of the RYGB via a hand sewn anastomosis between the existing gastric pouch and excluded stomach calibrated endoscope. The patient tolerated the procedure well, her diet was slowly advanced and she was discharged on POD6. She had no hypoglycemic episodes while inpatient. At her 2 week follow up, she reported no episodes of hypoglycemia, was tolerating PO . At her 3 month follow up, her post-prandial hypoglycemia symptoms had completely resolved and she was tolerating oral intake.