Sleeve gastrectomy (SG) is the most common bariatric procedure worldwide, offering satisfactory weight loss and low morbidity. However, revisional surgery is sometimes needed in the event of inadequate weight loss or significant weight regain. Possible options include gastric derivations, such as Roux-en-Y gastric bypass or one anastomosis gastric bypass, or biliopancreatic diversion (BPD) such as duodenal switch (DS) or single-anastomosis duodeno-ileal bypass (SADI). The latter two have shown excellent long-term weight loss outcomes and resolution of comorbidities. However, BPDs are associated with a risk of malnutrition and severe complications, including protein-calorie hypoabsorption, intractable diarrhea, and vitamin deficiencies, which can lead to osteoporosis or liver deficiency. The need for revisional surgery in such cases is rare and motivated by life-threatening situations (osteoporosis or liver deficiency), altered quality of life (intractable diarrhea, flatus intolerance), or surgical factors (common channel length, etc.). Revisional strategies, including common channel lengthening, transformations, or complete reversals, aim to resolve malnutrition while minimizing weight regain. Outcomes typically include improved nutritional parameters and reduced complications but at the cost of moderate weight regain. These revisions can easily be managed laparoscopically by experienced teams with acceptable morbidity, primarily linked to the problematic nutritional status. Preventative measures, such as strict nutritional follow-up and supplementation protocols, are essential to reduce revision rates and associated risks. While consensus on optimal revision techniques is lacking, a customized approach, based on patient conditions and surgical history, is crucial for successful outcomes.