Laparoscopic adjustable gastric banding is growing in popularity in the United States. A rare late complication is obstruction at the level of the band, with concentric gastric pouch dilation. In our patient, endoscopy showed gastric pouch dilation with food impaction and a restricted outlet. We describe the combined endoscopic and laparoscopic approach for alleviation of chronic obstruction as a late complication of an adjustable gastric band. This combined approach included laparoscopic band removal and scar excision with intraoperative endoscopic dilation.