Semaglutide vs Revisional Bariatric Surgery: What Is the Best Option for Suboptimal Clinical Response or Recurrent Weight Gain After MBS?

Background Despite metabolic and bariatric surgery (MBS) being the most effective option for weight loss and reducing obesity-related comorbidities, semaglutide presents a valuable noninvasive alternative, offering substantial weight loss with a lower risk of adverse effects. Objectives This study aimed to compare weight loss outcomes between patients receiving semaglutide and those undergoing revisional bariatric surgery (RBS) due to suboptimal clinical response (SCR) or recurrent weight gain (RWG). Methods A retrospective cohort study was conducted in patients who underwent bariatric surgery between 2015 and 2020 and had SCR or RWG postoperatively. These patients were managed with semaglutide (Group A) or RBS (Group B), either sleeve to RYGB or RYGB revision. The primary outcomes were excess BMI loss (%EBMIL), excess weight loss (%EWL), and total weight loss (%TWL) at 2 years following the new intervention. Results A total of 250 patients were included, 120 patients in Group A and 130 in Group B. Ninety percent (n = 225) of patients were female, with an average age of 41.3 ± 12 years. The mean BMI pre-intervention, at one year and two years follow-up, was 39.13, 37.45, and 40.36 Kg/m2 for Group A and 41.14, 34.01, and 34.94 Kg/m2 for Group B. Statistically significant differences in BMI were noted between the groups at one year (p = 0.001) and two years (p = 0.011). At two years, %EBMIL, %EWL, and %TWL were 8.32%, 6.1%, and 2.8% for Group A, and 36%, 45.76%, and 17.47% for Group B (p = 0.045, p = 0.006, and, p = < 0.001 respectively). Conclusion In patients with obesity who underwent an index bariatric procedure and experienced SCR or RWG, revisional bariatric surgery achieved greater weight loss outcomes compared to Semaglutide at 2-years follow-up.