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Background <p>Despite metabolic and bariatric surgery (MBS) being the most effective treatment for obesity and its related comorbidities, a significant proportion of patients experience recurrent weight gain (RWG) after primary surgery. In this setting, management options include revisional bariatric surgery (RMBS) and pharmacologic therapy with glucagon-like peptide-1 receptor agonists such as semaglutide. However, comparative data evaluating the effectiveness of both options for the management of RWG after primary MBS remain limited.</p> Objectives <p>This study aimed to compare weight loss outcomes between patients receiving semaglutide and those undergoing revisional metabolic and bariatric surgery (RMBS) due to RWG.</p> Methods <p>A retrospective cohort study was conducted in patients who underwent MBS between 2015 and 2020 and had RWG postoperatively. These patients were managed with semaglutide (Group A) or RMBS (Group B), including patients with previous sleeve gastrectomy that were converted to Roux-en-Y gastric bypass (RYGB) or patients with previous RYGB that underwent revision of the bypass. The primary outcomes were excess BMI loss (%EBMIL), excess weight loss (%EWL), and total weight loss (%TWL) at 2 years following the new intervention.</p> Results <p>A total of 250 patients were included, 120 patients in Group A and 130 in Group B. 90% (<i>n</i> = 225) of patients were female, with an average age of 41.3 ± 12 years. The mean body mass index (BMI) pre-intervention, at one year and two years follow-up, was 39.13 ± 8.53, 37.45 ± 8.95, and 40.36 ± 9.82 Kg/m2 for Group A and 41.14 ± 8.15, 34.01 ± 6.69, and 34.93 ± 8.51 Kg/m2 for Group B. Statistically significant differences in BMI were noted between the groups at one year (<i>p</i> = 0.001) and two years (<i>p</i> = 0.011). At two years, %EBMIL, %EWL, and %TWL were 8.32%, 6.1%, and 2.8% for Group A, and 36%, 45.76%, and 17.47% for Group B (<i>p</i> = 0.045, <i>p</i> = 0.006, and <i>p</i> &lt; 0.001 respectively).</p> Conclusion <p>In this specific cohort of patients with obesity who underwent a primary bariatric procedure and experienced RWG, RMBS was associated with greater weight-loss outcomes compared to semaglutide at 2-year follow-up. The lack of reported safety and complication data for RMBS limits definitive comparisons between management strategies.</p>

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Revisional Metabolic and Bariatric Surgery Versus Semaglutide: Which Strategy Has Greater Efficacy for Recurrent Weigh Gain After Primary Bariatric Surgery?

  • 期刊论文

  • 发表日期：

    2026年3月30日

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  • Yeisson Rivero-Moreno,
  • Arturo Estrada,
  • Diego Zamata-Ovalle,
  • Nawaf Hindosh,
  • Rodolfo Oviedo,
  • Jenny Choi,
  • Erin Moran-Atkin,
  • Diego Camacho

摘要

Background

Despite metabolic and bariatric surgery (MBS) being the most effective treatment for obesity and its related comorbidities, a significant proportion of patients experience recurrent weight gain (RWG) after primary surgery. In this setting, management options include revisional bariatric surgery (RMBS) and pharmacologic therapy with glucagon-like peptide-1 receptor agonists such as semaglutide. However, comparative data evaluating the effectiveness of both options for the management of RWG after primary MBS remain limited.

Objectives

This study aimed to compare weight loss outcomes between patients receiving semaglutide and those undergoing revisional metabolic and bariatric surgery (RMBS) due to RWG.

Methods

A retrospective cohort study was conducted in patients who underwent MBS between 2015 and 2020 and had RWG postoperatively. These patients were managed with semaglutide (Group A) or RMBS (Group B), including patients with previous sleeve gastrectomy that were converted to Roux-en-Y gastric bypass (RYGB) or patients with previous RYGB that underwent revision of the bypass. The primary outcomes were excess BMI loss (%EBMIL), excess weight loss (%EWL), and total weight loss (%TWL) at 2 years following the new intervention.

Results

A total of 250 patients were included, 120 patients in Group A and 130 in Group B. 90% (n = 225) of patients were female, with an average age of 41.3 ± 12 years. The mean body mass index (BMI) pre-intervention, at one year and two years follow-up, was 39.13 ± 8.53, 37.45 ± 8.95, and 40.36 ± 9.82 Kg/m2 for Group A and 41.14 ± 8.15, 34.01 ± 6.69, and 34.93 ± 8.51 Kg/m2 for Group B. Statistically significant differences in BMI were noted between the groups at one year (p = 0.001) and two years (p = 0.011). At two years, %EBMIL, %EWL, and %TWL were 8.32%, 6.1%, and 2.8% for Group A, and 36%, 45.76%, and 17.47% for Group B (p = 0.045, p = 0.006, and p < 0.001 respectively).

Conclusion

In this specific cohort of patients with obesity who underwent a primary bariatric procedure and experienced RWG, RMBS was associated with greater weight-loss outcomes compared to semaglutide at 2-year follow-up. The lack of reported safety and complication data for RMBS limits definitive comparisons between management strategies.