Outcomes and Management of Re-Establishing Bariatric Patients.

Abstract

Lifelong follow-up after metabolic/bariatric surgery (MBS) is necessary to monitor for patient outcomes and nutritional status. However, many patients do not routinely follow up with their MBS team. We studied what prompted MBS patients to seek bariatric care after being lost to follow-up and the subsequent treatments they received. A retrospective cohort study of patients after MBS who had discontinued regular MBS follow-up but represented to the MBS clinic between July 2018 and December 2022 to re-establish care. Patients with a history of a Sleeve Gastrectomy (SG), Roux-En-Y Gastric Bypass (RYGB), and Adjustable Gastric Banding (AGB) were included. We identified 400 patients (83.5% female, mean age 50.3 ± 12.2 years at the time of RBC), of whom 177 (44.3%) had RYGB, 154 (38.5%) had SG, and 69 (17.2%) had AGB. Overall, recurrent weight gain (RWG) was the most common reason for presentation for all three procedures (81.2% in SG, 62.7% in RYGB, and 65.2% in AGB; p<.001). SG patients were more likely to undergo a revision MBS compared to RYGB patients (16.9% vs. 5.8%, p<.001), while RYGB patients were more likely to undergo an endoscopic intervention than SG patients (17.5% vs. 7.8%, p<.001). The response to AOM agents, specifically GLP-1 drugs, was better in RYGB patients, than SG patients. This study highlights RWG as the most common reason for patients after MBS seeking to re-establish care with the MBS team. SG had a higher rate of revision MBS than RYGB, whereas endoscopic interventions were performed more frequently in the RYGB group. AOM, especially GLP-1 drugs, were more effective in RYGB patients.