This chapter explores the evolution of laparoscopic gastric bypass since its pioneering introduction in 1994 by Wittgrove and Clark. The procedure, initially a groundbreaking milestone, has gained widespread acceptance in both the medical community and the general public. Despite its complexity, the procedure stands out for its superior safety, cost-effectiveness, and patient acceptance. While the precise pathophysiology remains elusive, the positive outcomes underscore the procedure’s effectiveness and enduring impact in metabolic and bariatric surgery.