Purpose: To evaluate long-term weight loss, patient-reported benefit, regret, revisional surgery rates, and gastrointestinal symptoms 10 years after primary laparoscopic sleeve gastrectomy (SG) or gastric bypass (GB). Methods: Patients 10 years following primary SG or GB were contacted and invited to participate in structured follow-up. Participants completed a questionnaire and underwent blood testing and clinic review. Outcomes included body mass index (BMI), percent total body weight loss (%TBWL) at nadir and 10 years, self-reported health improvement, regret, revisional procedures, and prevalence of long-term gastrointestinal symptoms including reflux, bowel dysfunction, and abdominal pain. Results: Sixty-six patients participated (SG n=44, GB n=22); 48 were female (72%) and 18 male (27%). Mean pre-operative BMI was 45.6 kg/m² (SG) and 47.8 kg/m² (GB), with mean BMI at 10 years of 34.8 kg/m² and 31.0 kg/m², respectively. Mean nadir %TBWL was 37% at 20 months post-SG and 42% at 33.6 months post-GB. At 10 years, mean %TBWL was 24% (SG) and 32% (GB). Overall, 80% reported improved health at 10 years compared with pre-surgery, and 94% reported no regret. Long-term symptoms were common: in SG, 52% reported bowel issues, 58% reflux (96% requiring PPI), and 26% abdominal pain; in GB, 62% reported bowel issues, 24% reflux, and 23% abdominal pain. Revisional surgery occurred in 26%, including six SG-to-GB conversions and one re-sleeve. Conclusion: At 10 years, both SG and GB provide sustained weight loss and high patient satisfaction, with greater long-term %TBWL after GB. However, gastrointestinal symptoms and revisional surgery remain common, highlighting the importance of structured long-term follow-up and symptom surveillance.