Objective:

To evaluate the long-term effectiveness and safety of RYGB versus SADI after failed sleeve gastrectomy (SG) with a follow-up of at least 5 years.

Key Findings:

• SG may lead to insufficient long-term weight loss in 20-50% of patients, particularly those with severe obesity and type 2 diabetes.
• RYGB is often indicated for patients with SG-related gastro-esophageal reflux disease (GERD), but up to 25% may still not achieve optimal weight loss.
• SADI has gained popularity due to similar weight loss outcomes to BPD/DS but with fewer complications.
• Previous meta-analyses showed comparable short- and mid-term results for SADI and RYGB, but long-term data is lacking.

Interpretation:

There is no consensus on the best revisional procedure after failed SG, with both RYGB and SADI showing potential benefits, but further long-term studies are essential to establish their efficacy and safety.

Limitations:

• Most studies included in previous meta-analyses had small sample sizes (< 20 patients), which may introduce bias.
• Previous reviews focused primarily on short- and mid-term outcomes (12 to 36 months).
• Lack of conclusive evidence comparing SADI to RYGB in long-term outcomes.

Conclusion:

Further research, particularly randomized controlled trials, is needed to determine the long-term effectiveness and safety of RYGB versus SADI as revisional procedures after failed SG.