Abstract
Long-term weight regain is a fearedcomplicationof restrictive bariatric operation. The Sleeve Gastrectomy (SG) is still in its early stages as a primary bariatric surgery and long-term data about its efficacy remains limited. From the long term studies available it seems that approximately one-fifth of SG patients might be at risk for long-term weight regain and about 5-10% of total SG patients will require surgical management forit. The possible mechanism behind this weight regain is slowly being addressed. Patient noncompliance with dietary and lifestyle regimens is the most practical factor that needs to be considered and can be prevented with a multidisciplinary team. Long-term gastric pouch dilatation and gut hormone modulation are other theories that have been proposed to explain this weight regain. Successful management strategies to combat weight recidivism include revisional bariatric surgery, performing a resleeve gastrectomy or the addition of an adjustable band in the primary banded sleeve gastrectomy. However, the safety of revisional bariatric surgery is a concern and should be performed only by an experienced bariatric surgeon. It remains that as the SG continues to grow as a popular choice for the management of morbid obesity, more concrete long term information will become available to address the how and why weight regain occurs.
Highlights
Weight recidivism after primary bariatric procedures is an important issue and concern for many bariatric patients
We review the literature for weight regain following the Sleeve Gastrectomy, theorize why this complication can occur and recommend strategy options for dealing with this feared complication
D’hondt et al reported a trend of slight weight regain annuallyafter Sleeve Gastrectomy (SG) through observing continued decreasing Excess Weight Loss (EWL) at annual intervals; at 1 year follow up patients had a median EWL of 81.5% which dropped to 55.9% after 6 years [12]
Summary
Weight recidivism after primary bariatric procedures is an important issue and concern for many bariatric patients. SG, considered mainly a restrictive procedure, removes the greater curvature of the stomach, thereby reducing the size of the stomach to 60-80mL in capacity and modifying its shape to be more tubular in nature [4,5]. It has gained popularity as a standalone bariatric surgery due to its relative operational simplicity, lack of foreign body implantation and with an undisrupted gastrointestinal tract, it lacksthe dumping syndrome and nutrient deficiencies seen with the malabsorptive operations [6,7,8]. We review the literature for weight regain following the Sleeve Gastrectomy, theorize why this complication can occur and recommend strategy options for dealing with this feared complication
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