Metabolic and bariatric surgery remains one of the most effective interventions in the management of obesity and its associated medical conditions. The field has continuously grown to now encompass newer procedures that include one-anastomosis gastric bypass, single anastomosis duodeno-ileal bypass with sleeve gastrectomy, sleeve gastrectomy with transit bipartition, and single anastomosis sleeve ileal bypass. These procedures were developed with an aim to tackle current weight loss challenges and safety concerns that tend to present with the more common procedures. Taken together, they have been shown to induce excess weight loss ranging from 64% to 93% over 5 to 10 years, contribute to near-complete resolution of obesity-associated medical conditions, and simultaneously achieve lower rates of complications. However, as most of the current literature reports short-term outcomes, this review aims to identify and discuss their long-term efficacy and safety profiles, emphasizing the need for standardized guidelines that would encourage wider adoption and optimize patient outcomes.