Recurrent weight gain after sleeve gastrectomy: conversion to Roux-en-Y gastric bypass versus novel GLP-1 s

Area of Science:

• Bariatric Surgery
• Endocrinology
• Metabolic Health

Background:

• Sleeve gastrectomy (SG) is a common bariatric procedure, but recurrent weight gain (RWG) and suboptimal weight loss (SWL) can occur.
• Management options for RWG/SWL after SG include revision surgery or pharmacotherapy.

Purpose of the Study:

• To compare the efficacy of Roux-en-Y gastric bypass (RYGB) conversion versus semaglutide treatment for RWG/SWL post-SG.
• To evaluate weight loss, comorbidity improvement, and complication rates for both interventions.

Main Methods:

• Retrospective cohort study matching 87 RYGB patients with 87 semaglutide-treated patients post-SG.
• Matching criteria included age, gender, race, ethnicity, pre-SG to pre-intervention % total weight loss (%TWL), BMI, diabetes status, and time between procedures.
• Outcomes including %TWL, diabetes control, and complications were assessed over two years.

Main Results:

• RYGB resulted in significantly greater %TWL at two years (17.1% vs. 7.6%) and a higher proportion achieving >10% TWL (82.6% vs. 40.9%) compared to semaglutide.
• RYGB significantly improved diabetes medications and HbA1c, whereas semaglutide did not show significant changes.
• RYGB patients experienced more gastrointestinal surgeries and endoscopies; semaglutide responders (>5% TWL at 3 months) showed %TWL similar to the RYGB cohort at two years (22.9% vs. 17.1%).

Conclusions:

• RYGB offers superior and more consistent weight loss and diabetes management for SG patients with RWG compared to semaglutide.
• The benefit of RYGB comes with an increased risk of gastrointestinal interventions.
• A subset of patients responding to semaglutide achieved comparable weight loss outcomes to RYGB at two years.