Loading ...

TOPLINE:

Conversion surgery, particularly one-anastomosis gastric bypass, delivers greater and more durable weight loss than medication therapy in patients with recurrent weight gain after sleeve gastrectomy.

METHODOLOGY:

• Sleeve gastrectomy carries a notable risk for recurrent weight gain that may require revisional conversion to Roux-en-Y gastric bypass or one-anastomosis gastric bypass, procedures that are more complex than obesity medication therapy with agents such as GLP-1 receptor agonists.
• Researchers conducted a retrospective analysis of a prospectively maintained registry at a tertiary university hospital in Tel Aviv, Israel, to compare long-term outcomes with obesity management medications vs conversion surgery in patients treated for recurrent weight gain after sleeve gastrectomy between 2014 and 2024.
• Recurrent weight gain was defined as regaining more than 30% of nadir weight loss.
• Researchers assessed BMI at the last follow-up and total weight loss, with total weight loss of at least 20% considered satisfactory. Resolution of type 2 diabetes (T2D) and hypertension were also analyzed.

TAKEAWAY:

• Among 195 participants, 69 underwent one-anastomosis gastric bypass (mean age, 48.8 years; 20.3% men), 62 underwent Roux-en-Y gastric bypass (mean age, 53.9 years; 32.3% men), and 64 received obesity management medications (mean age, 55.9 years; 23.4% men). The medication group received GLP-1 receptor agonists including semaglutide (n = 58) and liraglutide (n = 8), and 11 patients received more than one medication during treatment.
• After a mean follow-up of 6.4 years, mean BMI differed significantly among the medication group (33.3), the one-anastomosis gastric bypass group (28.3), and the Roux-en-Y gastric bypass group (29.8; P = .0005).
• Mean total weight loss was significantly greater with one-anastomosis gastric bypass surgery (25.8%) and Roux-en-Y gastric bypass surgery (20.1%) than with medication (7.9%; P = .003).
• The proportion of patients who achieved total weight loss of at least 20% was significantly higher in the one-anastomosis gastric bypass group (68.1%) than in the Roux-en-Y gastric bypass group (46.7%) and the medication group (9.4%; P < .001).
• Resolution rates of T2D and hypertension were significantly higher in the surgery groups than in the medication group (P = .032 and P = .037, respectively).

IN PRACTICE:

“While pharmacological therapy may represent a reasonable initial approach in selected patients, conversion surgery remains the most effective option for patients with significant recur­rent weight gain after [sleeve gastrectomy],” the authors wrote.

SOURCE:

The study was led by Tom Krauze, Tel Aviv Sourasky Medical Center, Tel Aviv. It was published online in Obesity Surgery.

LIMITATIONS:

The study was retrospective and conducted at a single tertiary referral center. Treatment allocation to medication therapy or conversion surgery was not randomized and was influenced by clinical decision-making and patient preference. The follow-up rate was relatively low at approximately 70%, and follow-up duration differed among groups.

DISCLOSURES:

The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.