Abstract Background The most effective treatment for obesity and associated comorbidities is metabolic-bariatric surgery (MBS). Nevertheless, weight regain is reported in 10-30% of patients after Roux-en-Y gastric bypass (RYGB), eventually with a recurrence of obesity-associated comorbidities. Pouch resizing (PR), the resizing of an enlarged gastric pouch, is commonly performed as a low-risk secondary surgery to stabilize or even reduce the regained weight. However, the effectiveness of PR lacks scientific evidence. Aims To analyze the effect of PR after RYGB on long-term weight loss, course of comorbidities, complication rates and patient satisfaction. Methods Forty-eight patients undergoing PR between January 2016 and December 2020 were included. Data were collected retrospectively from a prospective database. PR was performed laparoscopically and included a resection of the enlarged gastric pouch and a redo of the gastrojejunostomy. Additionally, thirty-seven patients participated in a survey evaluating postoperative patient satisfaction. Results Nadir-weight after RYGB was reached after 26.3 ± 19.4 months; PR was performed after a mean time of 106.2 ± 45.5 months. Mean follow-up after PR was 55.9 ± 18.5 months. Mean BMI before PR was 39 ± 5.4 kg/m2. Mean BMI at 1, 3 and 5 years after PR was 37 ± 5.5 kg/m2, 35 ± 7.6 kg/m2 and 35 ± 7.5 kg/m2 respectively. Obesity-associated comorbidities were resolved in 53% of patients five years after PR. Postoperative complications analog grade ≤2 of the Clavien-Dindo classification occurred in 12.5% while complications grade ≥3 occurred in 10.4% of patients. There was no mortality. The postoperative survey showed high levels of satisfaction after PR. Conclusions PR for weight regain after primary RYGB is a safe procedure resulting in weight stabilization and resolution of obesity-associated comorbidities. PR is thus a valuable option to at least stop weight regain after primary RYGB in well-selected patients leading to high levels of patient satisfaction.