Vertical banded gastroplasty (VBG) has been largely abandoned due to late complications, including rare but serious erosion of the prosthetic mesh into the gastric lumen. A 46-year-old woman developed progressive epigastric pain, vomiting, and weight gain two decades after VBG. Endoscopic and radiological examinations revealed intragastric erosion of the polypropylene mesh, which was successfully removed endoscopically without complications. Persistent symptoms and lack of weight control, caused by altered gastric anatomy, required staged revision surgery. The patient subsequently underwent laparoscopic sleeve gastrectomy and then one anastomotic sleeve-ileal bypass. After the procedures, there was a permanent resolution of symptoms and satisfactory weight control during the 18-month follow-up. This case supports a combined endoscopic and surgical approach to manage the complex sequelae of VBG.