Objective:

To evaluate and compare the long-term results of obesity management medications (OMMs) versus conversion surgery (OAGB and RYGB) after sleeve gastrectomy (SG) in patients experiencing recurrent weight gain, focusing on total weight loss and resolution of obesity-related conditions.

Key Findings:

• Recurrent weight gain after SG occurs in 20-35% of patients, leading to increased conversion surgeries.
• OMMs, particularly GLP-1 receptor agonists, show promise as an adjunct or alternative to conversion surgery.
• Long-term outcomes of OMM therapy compared to conversion surgery remain under-researched, highlighting the need for further studies.

Interpretation:

A stepped-care approach utilizing OMMs may optimize weight control by providing effective management options, potentially reducing the need for more invasive surgical interventions in patients with recurrent weight gain post-SG.

Limitations:

• Retrospective design may introduce selection bias.
• Limited long-term data on OMM effectiveness compared to conversion surgery.
• The findings may not be generalizable due to the specific patient population and setting.

Conclusion:

OMMs could serve as a viable first-line treatment for recurrent weight gain after SG, potentially delaying or avoiding the need for conversion surgery, but further research is essential to validate these findings.