With more than 40% failures of gastric bypass in Body Mass Index>50 kg/m2, a successful alternative has to be proposed. Laparoscopic conversion of failed Roux-en-Y gastric bypass to biliopancreatic diversion with duodenal switch is technically feasible, safe and can be performed in 1 or 2 stages. This revision surgery is the most effective treatment to date, and should also be proposed for failed vertical-banded gastroplasty, adjustable gastric banding and Magenstrasse and Mill procedure, as it may provide the most durable weight loss of all revision surgeries with acceptable morbidity. This may result in lesser degrees of hypoproteinemia, commonly seen after distal gastric bypass.