Inclusion Criteria:  Age 18-89 Primary: Satisfies established NIH criteria for bariatric surgery Revision of sleeve gastrectomy: Sleeve gastrectomy performed at least two years prior but the patient did not reach 50% excess weight loss (EWL), has regained 20% of EWL since sleeve gastrectomy, or has current BMI > 40 Willing and able to provide his/her own consent for the surgery  Exclusion Criteria:  Contraindication to bariatric surgery Current pregnancy/breast feeding or plans for pregnancy Prisoners Previous history of gastrectomy other than sleeve gastrectomy for weight loss History of small bowel resection History of any kind of surgery to treat gastroesophageal reflux disease (GERD) History of or current Barrett's esophagus History of or any kind of cancer diagnosis in last 5 years Large hiatal hernia > 5 cm