This patient is a 58 year old woman with a history of peptic ulcer disease and has undergone five prior endoscopies revealing two persistent 1 cm prepyloric ulcers despite aggressive medical therapy. She elected to undergo a laparoscopic vagotomy and antrectomy. To begin, both anterior and posterior vagus nerves were mobilized and divided to decrease acid production. Next, the entire greater curvature of the stomach was mobilized by dividing the gastrocolic ligament. The first portion of the duodenum was also mobilized and transected with a Endoscopic GIA stapler. The hepatogastric ligament was divided and multiple additional applications of the Endoscopic GIA stapler was used to divide the stomach at the level of the body. Intraoperative ultrasound confirmed the location of the ulcers to ensure that they were included with the specimen. The Roux limb was then measured to sixty centimeters and a gastrojejunostomy created. The creation of the jejunojejunostomy followed. The laparoscopic vagotomy and antrectomy with roux-en-y reconstruction is a safe and effective method for the treatment of chronic ulcer disease.