Reversal of Long-Term Weight Regain After Roux-en-Y Gastric Bypass Using Liraglutide or Surgical Revision. A Prospective Study

Abstract

Purpose This study investigates whether pharmacotherapy with liraglutide is similarly effective in reversing weight regain more than 6 years after Roux-en-Y gastric bypass (RYGB) as revisional surgery aimed at restoring restriction. Methods Ninety-five consecutive patients (11 male, 84 female; mean BMI 45 ± 6 kg/m 2) undergoing RYGB 9 ± 4 years ago were treated for 24 months as follows: Patients, who gained less than 10% from weight NADIR, served as controls and were provided lifestyle counseling (DC, n = 30). The others were allowed to choose between three different treatment groups: daily s.c. administration of liraglutide (LG, n = 34); endosurgery using Apollo's Overstitch System™ (ES, n = 15), or implantation of a Fobi-ring with pouch resizing (FP, n = 16). Results Controls kept their weight stable during 24 months of study (− 0.1 ± 1.7 kg/m 2). Weight loss was 4.8 ± 2.9 kg/m 2 for LG and 5.5 ± 2.9 kg/m 2 for FP, both losing more than 85% of regained weight from weight NADIR (p < 0.001). In contrast, weight loss in ES was 1.0 ± 0.9 kg/m 2 (i.e., 20% of regained weight). Thirty-seven percent of FP experienced serious complications (p < 0.05) in contrast to the other groups. An improved prevalence of hypertension and dyslipidemia was observed in LG and FP (p < 0.02) 24 months after intervention. Conclusions Weight regain during more than 6 years after RYGB can be safely and effectively reversed with liraglutide. Compared with revisional surgery, pharmacotherapy with liraglutide was low risk and resulted in an important improvement in hypertension and dyslipidemia. Therefore, daily subcutaneous injections of liraglutide are a valid option to treat weight regain after RYGB.

Patients’ Experiences of Weight Regain After Bariatric Surgery

“…Besides medical nutrition therapy [41], psychosocial [42] and behavioral interventions [43] are important cornerstones in supporting lifestyle changes and self-care in patients with weight regain. Treatment with antiobesity medications may facilitate weight management and weight loss in patients with weight regain in the same way it does for patients who have not undergone surgery [44][45][46]. Further, revisional surgery may be a treatment option for some patients [46,47].…”

“…Treatment with antiobesity medications may facilitate weight management and weight loss in patients with weight regain in the same way it does for patients who have not undergone surgery [44][45][46]. Further, revisional surgery may be a treatment option for some patients [46,47].…”

Suboptimal Weight Loss 13 Years After Roux-en-Y Gastric Bypass: Is Hedonic Hunger, Eating Behaviour and Food Reward to Blame?

“…In addition, behavioural, dietary, psychological and medical factors can all play a role in long-term WL following bariatric surgery [ 11 , 62 ]. The use of GLP-1 analogues, as a weight loss aid, in patients with SWL or WR post-bariatric surgery has started to be investigated with promising results [ 63 ].…”

Therapieoptionen bei Weight-Regain nach Bariatrischer Operation

“…5,5% des Körpergewichtes oder ca. 4 BMI-Punkten erreicht werden kann [32,33,34]. Eine prospektive Studie konnte zeigen, dass Liraglutid 3,0 mg/d eine gleichwertige Wirkung bei Patienten mit bariatrischer Operation im Vergleich zu Patienten ohne bariatrische Operation hat [32,35].…”

“…1 BMI-Punkt) an Gewicht bspw. mittels OverStitch wieder reduziert werden konnte [24,33] (▶ Abb. 1 und ▶ Abb.…”