FIGURE 3. Conversion from vertical stapled gastroplasty (Mason) to Roux-en-Y-gastric bypass: A) schematic illustration of the conversion with the stapling line to perform the pouch is horizontally set, without crossing the previous vertical gastroplasty; B) adhesions in the region of the gastroplasty are solved, to identify the ring, a 45 mm stapler is set horizontally and a further stapler (60 mm) is also set vertically (medial or at the Mason gastroplasty) to allow distal flow, if the former pouch is not resected; the ring can be or not extracted, depending on the position of the new pouch; C) construction of the pouch using 45 stapler and the pouch is anastomosed to the alimentary limb, and a formal RYGB is performed.