Management of Recurrent Weight Gain After Sleeve Gastrectomy: Comparative Effectiveness of Conversion Procedures...

Recurrent weight gain after sleeve gastrectomy (SG) is a common long-term challenge, often requiring additional intervention. Management options include conversion surgery-most commonly to Roux-en-Y gastric bypass (RYGB) or One-anastomosis gastric bypass (OAGB), or treatment with obesity management medications (OMMs). Comparative long-term data between these strategies remain limited. This study aimed to evaluate long-term outcomes of OMM therapy versus conversion surgery after SG for recurrent weight gain.

A retrospective analysis of a prospectively maintained registry from a tertiary university hospital was conducted, including patients treated for recurrent weight gain after SG between 2014 and 2024. Patients underwent conversion surgery (OAGB or RYGB) or were treated with OMMs.

A total of 195 patients were included: OAGB (n = 69), RYGB (n = 62), and OMM (n = 64). Mean follow-up was 6.4 years. BMI at last follow-up differed significantly between groups (OMM 33.3 ± 5.1 kg/m², OAGB 28.3 ± 4.6 kg/m², RYGB 29.8 ± 4.9 kg/m²; p = 0.0005). Total weight loss (TWL) was also significantly higher in surgical groups (OMM 7.9% ± 8.4, OAGB 25.8%±11.2, RYGB 20.1%±10.5; p = 0.003). TWL ≥ 20% was achieved in 68.1% of OAGB patients, 46.7% of RYGB patients, and 9.4% of OMM patients (p < 0.001). Resolution of type 2 diabetes and hypertension was more frequent following surgical conversion. Revisional surgery rates were low and similar between surgical groups.

Conversion surgery following SG was associated with greater long-term weight loss and metabolic improvement compared with OMM therapy alone. Among surgical options, OAGB demonstrated the highest proportion of patients achieving clinically meaningful weight loss.