Open Roux-en-Y gastric bypass with a non-divided stapled only stomach pouch has a dehiscence rate that is at least 2 percent. A large dehiscence will result in food emptying into the distal stomach, loss of satiety, and eventual weight regain. A 63 year old white female who is status post open Roux-en-y gastric bypass presents four years later to our office after regaining all of her lost weight. Her weight at consultation was 312 lbs. (BMI=48 Kg/m2). An upper endoscopy revealed a gastric staple line that had completely separated and an anastomosis that was intact, no ulcers,and 12mm diameter. We performed a laparoscopic revision by stapling and dividing the stomach inferior to the Roux limb while under the guidance of an intraluminal endoscope. There were no postoperative complications following the laparoscopic revision surgery. The patient at 6 months after her revision has resolved her diabetes and lost 63 lbs or 38% of her excess body weight. Laparoscopic revisional surgery after open gastric bypass is feasible in selected patients. Intraoperative endoscopy is a valuable tool in assessing the anatomy before and after re-stapling the gastric pouch.