This patient is a 53 year old woman with a history of peptic ulcer disease and associated symptoms of nausea and vomiting. Upper endoscopy with ultrasound revealed retained food particles, a prepyloric ulcer and gastric outlet obstruction. Our plan was to perform a laparoscopic vagotomy and anterectomy with Roux-en-Y reconstruction. The entire hepatogastric ligament was divided using the harmonic scalpel. The greater curvature of the stomach was mobilized by dividing the gastrocolic ligament. The first portion of the duodenum was circumferentially mobilized and an Endo GIA stapler was used to transect at the first part of the duodenum. Multiple applications of the Endo GIA stapler were used to divide the stomach at the level of the gastric body, therefore, encompassing all of the gastric antrum. Both the anterior and posterior vagus nerves were mobilized and divided to decrease acid production and decrease the chance of marginal ulcers. We then proceeded to create a mesenteric defect in the transverse mesocolon. The Roux limb was then measured to sixty centimeters and a jejunojejunostomy anastamosis was created. The Roux limb was positioned retrocolic, retrogastric and a linear anastomosis was created between the Roux limb and the stomach. Pathology of the stomach antrum revealed gastritis, prepyloric ulcer, fibrosis and thickening of the muscle at pyloric region with no evidence of malignancy.