A 40 year old female who has a history of an open roux-en-y gastric bypass in the 1990s and regular tobacco use is referred for evaluation of reflux and weight regain (BMI 40.79 kg/m2) in the setting of a gastro-gastric fistula. During her pre-surgical evaluation, she was found to have a stage 1 squamous cell carcinoma within the middle third of her esophagus. This lesion was resected endoscopically with clear margins. Subsequently, she underwent a laparoscopic partial gastrectomy with roux-en-y reconstruction to excise the gastro-gastric fistula and to address the patient's reflux and weight regain. The patient did well and was discharged home on post operative day 2 with no complications. The patient had a successful outcome, losing 45 pounds and reaching a BMI of 29.22 kg/m2. Most importantly, her cancer has not recurred after almost 4 years of follow up. Of note, in the United States, esophageal cancer is very rare - making up about 1% of cases. In the US, the dominant form is adenocarcinoma, rather than our patient's initial presentation of squamous cell carcinoma; with early stages usually being completely asymptomatic. Thankfully, this was not the case with our patient. Our hopes are that repairing our patient's fistula/roux-en-y helps to minimize the chances of any future recurrence.