Roux-en-Y gastric bypass (RYGB) reversal is rare but offers significant symptom relief for select patients with complications.

• 199 patients underwent RYGB reversal over 16 years, 0.3% of 63,797 RYGBs.
• 86% reported symptom relief; highest in those with postbariatric hypoglycemia (94.6%).
• Complications are common: 24.6% had early severe complications, 21.6% experienced late complications.

Careful patient selection and setting realistic expectations are crucial for optimizing outcomes.