This is a video presentation displaying a technical approach to a Roux en Y Gastric Bypass to a Single Anastomosis Duodenal Ileostomy (SADI) in a patient with a history of a retrocolic gastric bypass who regained weight after 14 years from her bypass procedure and was seen in clinic with BMI of 65.10 and EGD showing an enlarged gastric pouch, elongated afferent limb, and an enlarged gastrojejunostomy anastomosis with a better surgical solution for weight loss.