Weight Recurrence After Sleeve Gastrectomy

Obesity remains a pressing global health concern, and bariatric surgeries, particularly sleeve gastrectomy (SG), have gained popularity as effective weight loss interventions. However, a significant challenge in post-surgical management is insufficient weight loss (IWL) and weight recurrence (WR) that can be observed in a subset of patients after bariatric surgery especially those who have undergone SG. Causes for WR after SG remain multifactorial and may include anatomic/technical considerations such as initial sleeve size, retained fundus, and sleeve dilation, inadequate follow-up support and education, increased ghrelin levels, and maladaptive lifestyle behaviors. The repercussions of WR after surgery can be profound, leading to the resurgence of comorbidities, a compromised quality of life, and potential negative economic implications. The gravity of this issue is underscored by reoperation rates, which can climb as high as 28% up to seven years after SG. Understanding the intricate reasons for WR after bariatric surgery is pivotal for the advancement of the field. This knowledge will not only shed light on the complexities of post-surgical weight management but also lays the foundation for the development of targeted techniques for identifying, treating, and preventing obesity recurrence. This chapter focuses on the topic of poor weight outcome after SG as the most common bariatric procedure worldwide, reviews its causes and potential therapeutic options to address it.