The amount of people suffering from obesity worldwide has nearly tripled in the last four decades. Bariatric surgery has proven to result in sustainable weight loss and reduced obesity-related comorbidities like type 2 diabetes, cardiovascular diseases and improves the psychological burden of patients with overweight. The complex anatomical design of the gastric bypass suggests that there are a number of gripping points for improvement of its original design. Optimizing the gastric bypass by changing the lengths of the limbs of the small intestine could result in more weight loss, reduction of obesity-related comorbidities and improvement in quality of life. By creating a longer gastric pouch or a banded gastric pouch using a non-adjustable ring weight loss could further improve by preventing weight regain. When results after a gastric bypass are insufficient and conservative interventions do not result in sufficient weight loss, revisional surgery shows promising results in selected patients.