Seven-Year Comparative Outcomes of One Anastomosis Gastric Bypass and Roux-en-Y Gastric Bypass for Weight Recurrence Regain Post Sleeve Gastrectomy

Background Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure worldwide; however, up to half of patients may require conversion surgery due to insufficient weight loss, weight recurrence, or complications. Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB-MGB) are the two most common conversion options, yet evidence regarding long-term comparative outcomes remains limited. Objective This study compared the long-term outcomes of RYGB and OAGB-MGB after SG, focusing on weight loss, comorbidity resolution, complication rates, and nutritional deficiencies. Methods We conducted a retrospective analytic study of all patients who underwent revisional RYGB or OAGB-MGB at our institution between January 2014 and December 2016. Data were extracted from electronic medical records, including demographics, comorbidities, perioperative details, and anthropometric and biochemical measures at baseline, 1, 5, and 7 years. Statistical analysis was performed using SPSS version 26. Results 109 patients were included (47 OAGB-MGB, 62 RYGB). Operative time was significantly shorter for OAGB-MGB. Both procedures achieved durable weight loss; however, OAGB-MGB yielded superior long-term outcomes, with greater %TWL and BMI reduction at one and seven years ( p  < 0.05). RYGB was significantly more effective for GERD resolution ( p  = 0.002). Rates of diabetes, hypertension, and dyslipidaemia remission were comparable. Complication rates were low and similar, though nutritional deficiencies, particularly iron deficiency, were more common in OAGB-MGB. Conclusion OAGB-MGB provided superior long-term weight loss, while RYGB offered better GERD resolution. Both procedures were safe and effective, underscoring the need for individualised procedure selection.