Long-Term Metabolic Remission and Predictive Factors After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in an Asian Population

<b>Background/Objective:</b> Bariatric surgery is an established treatment for individuals with severe obesity, providing sustained weight loss and improvement in obesity-related comorbidities. However, evidence on long-term outcomes and predictors of metabolic resolution, particularly among Asian populations, remains limited. We aimed to evaluate metabolic outcomes after bariatric surgery and identify predictive factors associated with remission. <b>Methods:</b> We retrospectively reviewed the data of 581 patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) at a tertiary care center between January 2012 and December 2022. Surgical techniques, postoperative follow-up, and baseline characteristics were recorded. Remission and improvement of metabolic comorbidities were assessed during 1-5 years of follow-up. Predictive factors were analyzed, and remission rates between SG and RYGB were compared using propensity score matching. <b>Results:</b> A total of 154 (26.5%) individuals had type 2 diabetes mellitus (T2DM), 162 (27.8%) hypertension (HT), 173 (29.7%) dyslipidemia (DLP), and 407 (70.0%) metabolic syndrome (MetS). Remission occurred in 79.1% of individuals with T2DM, 36.0% with HT, 33.9% with DLP, and 79.6% with MetS. Predictive factors included T2DM duration < 3 years, younger age for HT and DLP remission, male sex, body mass index < 43 kg/m², and fasting blood glucose level < 126 mg/dL for MetS. RYGB achieved higher remission of DLP than did SG, whereas other outcomes were comparable. <b>Conclusions:</b> Bariatric surgery effectively improves metabolic comorbidities, and several predictive factors influence outcomes. RYGB resulted in superior remission of DLP, while other metabolic outcomes were comparable between the two procedures.