Roux-en-y gastric bypass is a commonly performed procedure for morbid obesity and the associated metabolic syndrome, and less frequently, for intractable reflux disease. Occasionally, patients develop postoperative complications refractory to medical management or revision, such as severe malnutrition, marginal ulcer, or dumping syndrome. This video demonstrates a laparoscopic approach to reversal of Roux-en-y anatomy and highlights the key steps of the operation. In this case, the patient is a 63-year-old woman who had undergone gastric bypass for morbid obesity in March, 2019. Postoperatively, she struggled with severe recurrent marginal ulcer disease, eventually progressing to perforation at the gastrojejnual anastomosis. She required urgent exploratory laparotomy with open revision of the gastrojejunal anastomosis. Unfortunately, five months after this major operation, her symptoms returned in spite of maximal medical therapy. Her overall presentation was characterized by chronic epigastric pain and malnutrition; recurrent marginal ulcer was seen on endoscopy. Intraoperatively, we found ongoing inflammation of the gastrojejunal anastomosis involving the left lobe of the liver and the anterior surface of the pancreas. A combination of stapled and hand-sewn techniques are used to restore continuity to the stomach. The six critical steps of the operation are reviewed at the conclusion of the video.