A technique of divided, vertical pouch, Roux-en-Y gastric bypass is shown. The first patient had complications of sleep apnea, reflux esophagitis, hypertension, and severe back pain. An uncomplicated gastric bypass was performed. The second patient had a vertical banded gastroplasty years ago, but experienced constant severe heartburn recently. A conversion to divided gastric bypass was performed when a markedly dilated gastroplasty pouch with free esophageal reflux was found. Polyps, malignant pedunculated polyps, and large benign sessile lesions were found; the latter utilizing the piecemeal polypectomy technique devised by Shinya.