[Weight Recurrence After Bariatric Surgery: Definitions, Diagnosis, and Management Strategies. Part 2]

Weight recurrence (WR) represents the main long-term complication of bariatric surgery (BC) and the main cause of revisional surgery. The literature has been emphatic on the relevance of a preventive approach and multidisciplinary management to optimize long-term outcomes of BC.

To characterize the efficacy and safety of strategies for the management of WR in BC, analyzing outcomes in terms of weight loss and complication rates.

A review of the published literature on WR after bariatric surgery was conducted, focusing on medical and surgical management alternatives as revisional procedures. Comparative results in weight loss (%EWL) and associated complications are reported.

Weight recurrence (WR) management after bariatric surgery (BS) combines lifestyle changes, pharmacotherapy and surgical options. Behavioral intervention and remote monitoring programs, such as the HELP platform, have shown efficacy in improving weight loss. Pharmacotherapy includes agents such as GLP-1 (liraglutide and semaglutide) and combinations such as naltrexone/bupropion, with promising results although limited by local availability. Revisional surgical interventions such as pouch or stoma reduction, endoscopic procedures (TORe, ROSE) and advanced options such as duodenal switch and distal gastric bypass (RYGB) have demonstrated efficacy but require experience and multidisciplinary management.

Management of WR after BS requires a multidisciplinary approach that identifies multifactorial causes and risks. Stepwise management (behavioral, pharmacological, surgical) tailored to each patient is key. Expectations should be defined from the outset, and in case of revisional surgery, anatomy and nutritional deficiencies should be evaluated to minimize risks.