We present the case of a 29-year-old female who presents for weight regain after an LSG. The patient has re-gained half of the weight loss in the last four years. She has a history of a primary laparoscopic ventral gastric band, subsequent removal, and a LSG. The patient was scheduled for a laparoscopic conversion of SG to RYGBB. The abdominal cavity was accessed via supraumbilical, subxiphoid, right, mid, and left upper quadrant trocars. Upon examination, adhesions were observed and taken down between the stomach and the left diaphragmatic crus, and the omentum and greater gastric curvature. The stomach was transversely divided creating a 40 cc pouch. Fifty centimeters from the ligament of Treitz, the small bowel was transected and the distal limb was brought to the upper abdomen in an antecolic-antegastric fashion for a side-to-side gastrojejunostomy. A hundred and fifty centimeters distal to the gastrojejunostomy, a side-to-side jejunojejunostomy was performed between the biliopancreatic and alimentary limbs. Thorough hemostasis was performed and a drain was placed in the left upper quadrant abdomen. The procedure finalized with the patient under stable condition.