Background <p>With the recent endorsement of the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) as a modification of the biliopancreatic diversion with duodenal switch (BPD/DS), long-term data regarding their comparison is scarce. This study aimed to compare the 10-year efficacy and safety outcomes of BPD/DS and SADI-S.</p> Methods <p>A retrospective review of patients undergoing BPD/DS and SADI-S as primary procedures was conducted at two centers. Outcomes assessed were weight loss, remission of obesity-related medical conditions and early and late complications. Chi-squared tests, <i>t</i>-tests for parametric data and Mann Whitney U tests for nonparametric data, and a linear fixed effects model were used for statistical analysis.</p> Results <p>101 patients underwent BPD/DS and 32 underwent SADI-S between 2008 and 2014. Mean preoperative body mass index (57.5 ± 9.5&#xa0;kg/m² in BPD/DS vs 59.9 ± 9.7&#xa0;kg/m² in SADI-S, <i>p</i> = 0.208) and age (46.9 ± 11.0&#xa0;years in BPD/DS vs 43.3 ± 11.3&#xa0;years in SADI-S, <i>p</i> = 0.102) were comparable between both groups. The mean percentage total weight loss (%TWL) at all time points, the maximum % TWL (45.7 ± 9.6% in BPD/DS vs 47.3 ± 10.1% in SADI-S, <i>p</i> = 0.418), and remission rates of obesity-related medical conditions were similar. The SADI-S group experienced more intraoperative complications (<i>n</i> = 3 vs n = 0 in BPD/DS, <i>p</i> = 0.013) and longer hospital length of stay (4 vs 3&#xa0;days in BPD/DS, <i>p</i> &lt; 0.001). More nutritional complications were seen after BPD/DS (53.5% vs 15.6% in SADI-S, <i>p</i> &lt; 0.001). Rates of early and late complications were comparable between both cohorts.</p> Conclusions <p>Although SADI-S is a relatively newer technique, long-term results seem promising, especially when compared to the traditional DS, which is known to raise safety and nutritional concerns. More long-term comparative studies are needed to contribute to this growing data.</p> Graphic Abstract <p></p>