Abstract:
© 2017 Nova Science Publishers, Inc. Weight regain has long been recognised as a complication of bariatric surgery with recent work suggesting that it may be most common following sleeve gastrectomy. Weight regain is an important complication due to its association with recurrence of diabetes, deterioration in quality of life and economic implications. Despite this, weight regain remains inconsistently reported and poorly understood. The phenomenon of weight regain following bariatric surgery has no consensus definition. In the small number of series where it is reported, the definition may be any weight regain or an increase in an arbitrarily chosen value such as an increase of 10kg, 5kg/m2 or 25%EWL from the post-operative weight loss nadir. The result is that reported rates of regain vary from 6% at two years to 76% at six years post-operatively. The causes of weight regain after sleeve gastrectomy have not been definitively established. A systematic review revealed five possible contributors: technical factors, sleeve dilatation, ghrelin levels, maladaptive lifestyle behaviours and lack of adequate follow-up support. Further studies are required to understand the underlying mechanisms definitively. The management of weight regain following sleeve gastrectomy is not well described. Management guidelines are difficult to formulate given the variability in definition, incomplete understanding of its etiology and lack of robust evidence for revision procedures. Currently, management varies from observation to major revision surgery and is generally tailored to the patient and is dependent on the options available at the treating bariatric service. Weight regain following sleeve gastrectomy is a common complication with significant implications. To date, its understanding and management have been hampered by the lack of a standardised definition and paucity of robust studies. Once these issues are addressed, the identification and management of weight regain following sleeve gastrectomy will be able to be optimised.