Medical tourism is the practice of traveling across international borders to access healthcare systems or physician services that are not available or are less attractive in a person's native country. Medical tourism is often driven by high health care costs or long wait times. Frequently patients seek out surgeries abroad which are usually paid for out-of-pocket. Bariatric surgery treatment costs can be 20-30% less than those in the U.S. However, in pursuing bariatric surgery abroad patients also bypass the critical infrastructure present within accredited bariatric surgery centers in the U.S. When complications arise, patients often lack medical records or operative reports. Here we present a case of weight regain after a reported laparoscopic gastric sleeve. Intraoperatively the stomach was found to be abnormally plicated, which changed the operative plan from conversion of sleeve gastrectomy to Roux-en-Y gastric bypass, to subtotal gastrectomy and Roux-en-Y esophagojejunal reconstruction. This case highlights the challenges of revisional bariatric surgery, particularly in the setting of bariatric tourism.