Here we present a case of a 72 year-old female with a history of stage I adenocarcinoma of the gastric antrum treated with EMR. She underwent surveillance at 6 month intervals with upper endoscopy. A recurrent nodule at the resection site was found at 12 months following resection with biopsy demonstrating high-grade dysplasia 12 months following resection. She was taken to the operating room and underwent laparoscopic distal gastrectomy with hand-sewn Billroth I reconstruction using barbed, self-anchoring suture. Surgical pathology showed all margins free from dysplasia and all examined lymph nodes were negative.