Factor V deficiency is a rare bleeding disorder requiring special attention during the peri-operative period. Surgical intervention in these patients can be technically challenging. Because of the rarity of this condition, the optimal management is unknown. Available literature supports peri-operative infusion of fresh frozen plasma. We report successful management of a factor V deficient patient undergoing Roux-en-Y gastric bypass. Literature review indicates that this is the first reported case of bariatric surgery in a patient with factor V deficiency.