A Comprehensive Review of Sleeve Gastrectomy,Roux-en-Y Gastric Bypass,One-Anastomosis Gastric Bypass,Duodenal Switch,and SADI-S: Very Long-Term Outcomes at 10 Years and Beyond

Abstract

Background:

Metabolic and bariatric surgery is the most effective treatment for severe obesity. While short- and mid-term results are well documented, very long-term data (≥10 years) remain scarce, particularly for newer procedures. This review aims to synthesize the available evidence on weight loss outcomes, comorbidity resolution, and complications at 10 years and beyond for the five main bariatric procedures.

Methods:

A comprehensive literature review was performed using PubMed, MEDLINE, and Cochrane databases. Studies reporting outcomes at ≥10 years for sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis duodeno-ileal bypass with sleeve (SADI-S) were included.

Results:

At 10 years, weighted mean %TWL ranged from 24.4% for SG to approximately 40% for BPD-DS. The SLEEVEPASS randomized controlled trial demonstrated superior weight loss with RYGB compared to SG (%EWL 51.9% versus 43.5%, P < .05). OAGB showed excellent durability with a %EWL of 64.1% at 10 years. BPD-DS achieved the highest sustained weight loss (%EBMIL 76.5%–78%) but with significant nutritional concerns. SADI-S data at 10 years showed %EWL of 80% with acceptable complication rates. Type 2 diabetes remission rates varied from 26% to 33% (SG/RYGB) to >90% (BPD-DS). Gastroesophageal reflux disease (GERD) emergence was a major concern after SG (31% esophagitis at 10 years versus 7% after RYGB).

Conclusions:

All five procedures demonstrate durable weight loss at 10+ years, with a clear hierarchy favoring malabsorptive procedures for weight loss efficacy. Procedure selection should consider patient-specific factors, including baseline BMI, presence of GERD, metabolic comorbidities, and capacity for long-term nutritional follow-up.