Revisional Surgery or Pharmacotherapy for Insufficient Weight Loss and Weight Regain After Primary Bariatric Procedure: a Descriptive Study

Abstract

Bariatric surgery is the most effective and durable treatment option for clinically severe obesity. Unfortunately, some degree of weight regain (WR) is common after nadir weight is achieved. Pharmacotherapy and revision surgery are potential options to treat this phenomenon. We aim to determine the efficacy of both approaches in patients with WR versus insufficient weight loss (IWL). We retrospectively reviewed a prospectively collected database of patients who underwent bariatric surgery from 2008 to 2018 with IWL or WR. Of 422 patients with WR or IWL after bariatric surgery, 150 patients were placed on pharmacotherapy and 27 underwent revisional surgeries. Mean age of patients was 41.4years and mean BMI was 42.1kg/m2. The most common conversion surgery was LSG to RYGB. % Total weight loss (TWL) was higher in IWL group (23.8% ± 11.0) compared to WR group (17.2% ± 7.9) in revisional surgery (p = 0.02). The converse was observed for pharmacotherapy, with %TWL 1.9% in the WR group compared to 0.7% in the IWL group (p = 0.0067). Patients with IWL or WR had modest weight loss with adjunctive use of pharmacotherapy after primary bariatric surgery. Conversely, revisional surgery is an effective treatment for both IWL and WR.