Background <p>Previous studies showed a high conversion rate and failure of restrictive procedures, including sleeve gastrectomy (SG), adjustable gastric banding (AGB), gastric plication (GP), and vertical banded gastroplasty (VBG) in a long-term follow-up. The current study aims to evaluate the efficacy and safety of a revisional one anastomosis gastric bypass (OAGB) for weight loss and treatment of obesity-related problems after primary metabolic and bariatric restrictive procedures.</p> Methods <p>A retrospective study on prospectively collected data was conducted on a sample of 151 patients who experienced insufficient weight loss or weight regain after primary restrictive surgeries and underwent OAGB as a revisional procedure.</p> Results <p>A total of 151 patients with a history of previous restrictive metabolic and bariatric surgery who underwent a revisional OAGB were included in this study. The restrictive procedures consisted of SG (<i>n</i> = 79), AGB (<i>n</i> = 45), GP (<i>n</i> = 15), and VBG (<i>n</i> = 12). Total weight loss percent (%TWL) after the revisional OAGB was 27.03 ± 9.12, 27.74 ± 10.05, 24.62 ± 9.87, and 24.34 ± 8.05 after 12, 24, 60, and 84 months, respectively. After 24 months of follow-up, TWL was significantly higher in the GP group compared to the AGB group. However, weight loss outcomes were not significantly different after 60 months of follow-up. The revisional OAGB was associated with a significant resolution of obesity-related problems, including type 2 diabetes (55.55%), hypertension (50%), dyslipidemia (77%), and obstructive sleep apnea (100%) after 2 years of follow-up. There was no serious complication after the revisional OAGB in the short- and long-term follow-up.</p> Conclusion <p>OAGB is an efficient and safe option as a conversion surgery after restrictive procedures.</p>