Complications after sleeve gastrectomy (SG) unfortunately lead a subset of patients to require revisional surgery, including conversion to Roux-en-Y gastric bypass (RYGB). We aimed to describe the indications for conversion and perioperative outcomes in this subset of patients. Academic hospital, Abu Dhabi, United Arab Emirates. All patients undergoing conversion from SG to RYGB from September 2015 to December 2018 were retrospectively reviewed. Patients who underwent conversion solely for weight recidivism were excluded from analysis. Forty-seven patients underwent conversion to RYGB due to complications from SG. The cohort was 76.5% female with a mean age of 39 years and median body mass index of 34 kg/m2. The median time between SG and RYGB was 36 months. Indications warranting conversion included mechanical complications (n = 24, 51.1%), intractable reflux (n = 21, 44.7%), and fistula (n = 2, 4.2%). Preoperative mechanical abnormalities included hiatal hernia (n = 13, 27.7%), helical twist (n = 10, 21.3%), sleeve stenosis/stricture (n = 5, 10.6%), fistula (n = 2, 4.2%), and leak (n = 1, 2.1%). Each conversion was completed with a laparoscopic approach, with a median length of stay of 3 days. Four patients (8.5%) experienced complications within 30 days, including 2 patients (4.2%) with superficial surgical site infection, 1 patient each (2.1%) with gastrointestinal hemorrhage and anastomotic leak. There were no mortalities at a median follow-up of 17 months. In this series, representing the largest reported single-center experience in the Middle East, conversion of SG to RYGB was safe and effective for the treatment of symptoms and mechanical complications after SG. Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.