Life following metabolic and bariatric surgery: up to 19 years follow-up, results from a tertiary centre.

BACKGROUND: Metabolic and bariatric surgery (MBS) is an established treatment for severe obesity, yet data on very long-term patient-reported outcomes remain limited. This study assessed satisfaction, quality of life (QoL), perceived postoperative benefit, and work-related function up to 19 years after MBS. METHODS: This single-centre prospective follow-up study included adults who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) at NHS Lothian, between 2006 and 2025. Patient-reported outcomes were evaluated using structured satisfaction questionnaires, the Bariatric Analysis and Reporting Outcome System (BAROS), the Bariatric Quality of Life index (BQL), benefit-ranking measures, and employment-related questionnaires. Outcomes were compared across demographic, socioeconomic, clinical, procedural, and weight-loss subgroups. RESULTS: Among 559 eligible patients, 174 completed multidomain follow-up questionnaires. Respondents were predominantly female (78.2%), with a median age of 48 years and median follow-up of 10 years; 51.1% had follow-up of at least 10 years. Overall, 52.3% underwent LSG and 47.7% underwent RYGB. Median total weight loss was 23.7%, and 75.9% achieved greater than 50% excess weight loss. Satisfaction was high: 87.7% were satisfied with their surgical outcome, 90.6% would undergo surgery again, and 89.9% would recommend MBS. Median satisfaction score was 9.5/10. Improved self-confidence and QoL were reported by 84.1% and 89.9% of patients, respectively. Median BAROS score was 3.50, indicating a good outcome, and mean BQL score was 49.7 ± 8.41. Greater weight loss was significantly associated with higher satisfaction, improved self-confidence, improved QoL, and higher BAROS and BQL scores. Outcomes were broadly comparable by sex, age, procedure type, follow-up duration, and diabetes status. Employment status did not significantly change, but weight and emotion-related work limitations improved substantially after surgery. CONCLUSION: MBS was associated with sustained long-term satisfaction, improved QoL, and better functional work capacity up to 19 years after surgery. Weight-loss response was the strongest determinant of perceived success.