Surgical approach of weight regain after bariatric surgery

摘要

Abstract: Bariatric surgery is the most effective treatment for obesity. A significant long-term complication of bariatric surgery is weight regain. Weight regain is associated with the return of several obesity-related comorbidities and increased economic burden. Surgical complications from the index procedure, such as sleeve and pouch dilatation, expansion of the gastrojejunostomy, “neofundus” formation, or gastro-gastric fistulas, play a major role in the pathophysiology of weight regain. The most frequent mechanisms are the loss of restriction and insufficient malabsorption. Poor adherence to nutritional recommendations, the lack of physical activity and mental disease are also important. Percent of maximum weight loss seems to be the most clinically relevant tool to measure and follow weight regain in the postoperative period. Ten to forty percent of patients will experience significant weight regain after the first 12 to 18 months of sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass. The evaluation of weight regain is multidisciplinary. Contrasted studies such as an upper gastrointestinal series and upper endoscopy are mandatory. An effective treatment option for weight regain is revisional surgery. However, revisional surgery is technically challenging and is often associated with increased risk of complications. Technical factors from the index surgery and a thorough preoperative evaluation are central to the selection of the appropriate revisional procedure. Endoscopic and robotic platforms are being employed to address revisional surgery.