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Roux-en-y Gastric Bypass has long been touted as an antireflux procedure, and it is for the most part. There are instances however, of GERD after Roux en Y gastric bypass that require medical and in some patients, surgical therapy. This Surgical Open Classroom discusses the issues of GERD and morbid obesity and what to expect with Roux en Y gastric bypass. It also looks at some of the currently available surgical treatment options for post Roux en Y gastric bypass GERD and some details on expected outcomes. A video is included to show the difficulties and necessary steps in the repair.