A sleeve stricture is usually a delayed diagnosis; however, it can occur acutely. When this happens, the sleeve can be saved when using the over-under technique. This is done by transecting the stomach at the stricture and pulling the superior portion over the lower portion and firing a 60-mm mechanical stapling device. The resulting defect is hand-sewn closed. This allows the patient to keep their pylorus and avoids the complications associated with conversion to Roux-en-Y gastric bypass. There have been no previous reports of this technique which can be used to treat both acute and chronic strictures.