Weight Recidivism After Bariatric Surgery: A Narrative Review

Bariatric surgery, while effective for severe obesity, is often challenged by postoperative weight regain (WR), affecting 20-30% of patients. This review analyzes the mechanisms, risk factors, and management strategies for WR, emphasizing surgical considerations. WR is influenced by hormonal adaptations, including ghrelin rebound and leptin resistance, as well as metabolic adaptation, leading to reduced resting energy expenditure. Surgical factors, such as suboptimal technique, gastro-gastric fistulas, and stomach/anastomosis dilation, significantly contribute to WR. Specifically, inaccurate sleeve or pouch sizing, poorly calibrated anastomoses, and complications with gastric banding necessitate careful surgical planning and potential revision. Management strategies encompass lifestyle interventions (diet, exercise, behavioral therapy), pharmacotherapy (GLP-1 receptor agonists like liraglutide, semaglutide, and tirzepatide), and revisional surgery. Revisional procedures, including sleeve-to-bypass, bypass revision, sleeve-to-duodenal switch/SADI, and band removal with conversion to sleeve or bypass, address anatomical failures and enhance weight loss. Distinguishing surgical failure from patient nonadherence is crucial for appropriate intervention. Ultimately, a collaborative, multidisciplinary approach integrating these strategies optimizes long-term weight management and improves patient outcomes after bariatric surgery.