Recurrent weight gain after sleeve gastrectomy: conversion to Roux-en-Y gastric bypass versus novel GLP-1 s

Jul 2, 2025Surgical endoscopy

Repeated weight gain after sleeve gastrectomy: comparing stomach bypass surgery and new GLP-1 treatments

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Abstract

Two years after intervention, Roux-en-Y gastric bypass (RYGB) resulted in a 17.1% total weight loss compared to 7.6% for semaglutide.

RYGB patients were significantly more likely to achieve over 10% total weight loss compared to those treated with semaglutide (82.6% vs. 40.9%).
Diabetes medications and mean HbA1c levels significantly decreased after RYGB, while no such improvements were observed in the semaglutide group.
RYGB was associated with higher frequencies of gastrointestinal surgeries and endoscopies.
Among semaglutide 'responders', the two-year total weight loss was similar to that of RYGB patients (22.9% vs. 17.1%).
Only a minority of patients treated with semaglutide met the criteria for response.

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PURPOSE: This retrospective cohort study aims to compare outcomes of Roux-en-Y gastric bypass (RYGB) versus semaglutide for treatment of recurrent weight gain (RWG) and suboptimal weight loss (SWL) after sleeve gastrectomy (SG).

METHODS: Patients at a tertiary care hospital who underwent RYGB conversion after SG (n = 87) were matched 1:1 to SG patients treated with semaglutide (n = 87) by: age, gender, race, ethnicity, pre-SG to pre-intervention total weight loss (%TWL), BMI, diabetes status, and time between SG and intervention. Semaglutide 'responders' (defined as ≥ 5% TWL at three months, n = 26) and non-responders were similarly compared to the overall RYGB cohort. Weight, comorbidity, and complication outcomes were collected for two years post-intervention.

RESULTS: %TWL two years post-intervention was greater in the RYGB compared to the semaglutide cohort (17.1% vs. 7.6%, mean difference = 9.5%, 95% CI [2.6, 16.4], p = 0.002), as was the proportion of patients who achieved > 10% TWL (82.6% v. 40.9%, p < 0.001). Diabetes medications (p = 0.018) and mean HbA(p = 0.006) decreased significantly in the RYGB but not semaglutide cohort. RYGB patients had increased frequencies of GI surgeries and endoscopies. For semaglutide 'responders,' two-year %TWL was similar to RYGB (22.9% vs. 17.1%, p = 0.423). 1c

CONCLUSIONS: RYGB led to greater and more consistent weight loss and diabetes control than semaglutide in SG patients with RWG, at the cost of an increased need for GI interventions. While only a minority of patients responded to semaglutide, these patients had similar two-year weight outcomes as RYGB.

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Recurrent weight gain after sleeve gastrectomy: conversion to Roux-en-Y gastric bypass versus novel GLP-1 s

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