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The laparoscopic Roux-en-Y gastric bypass (RYGB) is currently one of the most common bariatric procedures. However, RYGB can cause specific undesired side effects related to the bypassing of a large part of the stomach, duodenum, and the proximal jejunum. These side effects include early dumping syndrome, hypoglycemia, malnutrition, severe diarrhea and excessive nausea, and vomiting. Although these conditions can usually be managed conservatively, occasionally a surgical reintervention may be required. Hence different reversal techniques, including endoscopic approaches, have been described. In extreme cases surgical options include reversal to normal anatomy (NA) or into sleeve gastrectomy or sleeve-like resection (NASG) to address undesired side effects. This procedure usually requires dismantling both the gastrojejunostomy and the jejunojejunostomy, reanastomosing the gastric pouch into a gastric remnant, and the proximal alimentary limb end into a distal biliary limb end. Eventually, concomitant hiatal hernia repair may be required.
