Purpose <p>To compare short- to mid-term weight loss outcomes, safety, and functional tolerance between Minimizer ring implantation and pouch revisional surgery in patients presenting with recurrent weight gain or functional failure after Roux-en-Y gastric bypass (RYGB).</p> Methods <p>This retrospective observational study included patients undergoing revisional bariatric surgery after RYGB between 2020 and 2025 at a single Swiss bariatric center. Revisional strategies comprised Minimizer ring implantation and pouch-based revisions. Outcomes assessed included percentage total weight loss (%TWL), body mass index (BMI) changes, postoperative complications, reinterventions, and functional tolerance at 3, 6, and 12 months. Non-parametric statistical methods were applied.</p> Results <p>27 patients were analyzed (14 Minimizer ring implantations, 13 pouch revisions). Both strategies achieved progressive weight loss with no significant differences in %TWL at 3, 6 and 12 months. Early postoperative complication rates were similar in both groups. Minimizer ring implantation was associated with a higher rate of late intolerance and secondary interventions leading to ring removal.</p> Conclusion <p>Within the available 12-month follow-up, no statistically significant difference in weight loss was detected between Minimizer ring implantation and pouch revisional surgery. Minimizer ring implantation was associated with a higher observed burden of intolerance and secondary interventions in this cohort. Pouch revision may provide anatomical correction without foreign-body-related complications. These findings should be considered hypothesis-generating and suggest that future studies should assess cumulative reintervention burden across revisional strategies.</p>