Adhesions from prior surgery is not an absolute contraindication to a Roux en Y gastric bypass. It is important to read the operative notes and communicate with the patient about realistic outcomes from the surgery. This video case report describes a 51-year-old female with a history of two prior aborted sleeve gastrectomies, both for different reasons. She developed two incisional hernias as a result of the first aborted procedure. Due to the need for an incisional hernia repair and the development of diabetes and gastroesophageal reflux disease, she underwent a Roux en Y gastric bypass. The operation was extensive, involving prolonged adhesiolysis and a Bougie divided intraoperatively with a stapler necessitating further repair. Despite this she made a swift recovery, her comorbidities are improving or resolved, and she continues to lose weight in hopes of eventually repairing her incisional hernia.