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Our patient is a 33-year-old female with a BMI of 42 and an excess body weight of 110 pounds who underwent a robot-assisted laparoscopic biliopancreatic diversion with duodenal switch (RA LBPD/DS). This procedure begins with an appendectomy, followed by creation of the ileo-ileostomy anastomosis. A cholecystectomy is completed followed by the sleeve gastrectomy. The duodeno-ileal anastomosis is made with a retrocolic Roux limb via a robot-assisted hand-sewn anastomosis. Mesenteric defects are closed to prevent internal hernias. A methylene blue leak test ensures the anastomosis is patent and secure. Our patient has lost 30% of her excess weight in one month.