Introduction: Mutations in the E-cadherin (CDH1) gene confer an 80% lifetime risk of hereditary diffuse gastric cancer (HDGC).1 Due to unreliable screening modalities, prophylactic total gastrectomy (PTG) is recommended for individuals at risk for HDGC.2,3 Due to genetic anticipation (cancer occurring at an earlier age with each successive generation), the age at which PTG is recommended is not clearly defined, but generally recommended before 20 years of age.4 We present the case of an asymptomatic 15-year-old male, positive for CDH1 mutation, with a strong family history of HDGC (father and paternal uncle, both died from biopsy-proven diffuse gastric cancer at ages 42 and 15, respectively), who underwent a laparoscopic PTG for the prevention of HDGC. Materials and Methods: Preoperative evaluation included genetic, psychological, endocrine, nutritional, and surgical evaluations; the patient essentially went through our adolescent bariatric surgery program. Upper gastrointestinal endoscopy was unremarkable. His comorbidities included obesity (body–mass index 34 kg/m2), asthma, and depression. A laparoscopic PTG with Roux-en-Y esophagojejunostomy reconstruction was planned. Intraoperatively, with patient in the supine position, five working ports were placed. The gastrocolic ligament was divided and mobilized to the angle of His with division of the short gastric vessels. The duodenocolic ligament was incised, and the first portion of the duodenum was cleared circumferentially and transected 2 cm distal to the pylorus. The right and left gastric vessels were divided. The gastroesophageal junction was cleared circumferentially. An esophagogastroscopy was performed to localize and mark the Z-line, and the distal esophagus was divided with a stapler. A Roux limb was created dividing the proximal jejunum 50 cm distal to the ligament of Treitz. A 150 cm limb was measured, and a side-to-side enteroenterostomy was created with a linear stapler. A window was made in the left mesocolon and 20 cm of Roux limb was passed through this window into the lesser sac. A hand-sewn, two-layered end-to-side esophagojejunostomy was created. An air leak test was performed and no air leaks were identified. The gastrectomy specimen was removed and no intraoperative complications occurred. Results and Conclusions: The operative time was 117 minutes, estimated blood loss was 40 mL, and the patient tolerated the procedure well. A water-soluble contrast esophagogram was performed the following morning, which showed no contrast extravasation. His diet was advanced and he left the hospital without sequelae. Pathologic evaluation of the specimen revealed no invasive cancer. With a mean follow-up of 6 months, no perioperative complications have been identified. In conclusion, laparoscopic PTG can be safely and effectively performed in childhood kindreds at risk for HDGC; until more is known about when these patients develop gastric cancer, strong consideration should be given to perform prophylactic gastrectomy during mid-teenage years in patients with a family history of early gastric cancer. The authors have no conflicts of interest to report. Runtime of video: 5 mins Presented as a video presentation at the International Pediatric Endosurgery Group's (IPEG) 23rd Annual Congress for Endosurgery in Children, held in conjunction with the British Association of Pediatric Surgeons (BAPS). The meeting occurred from July 22–26, 2014 at the Edinburgh International Convention Center (EICC), in Edinburgh, Scotland.