Skip to main content

Advertisement

SpringerLink
Log in

Semaglutide and Tirzepatide for the Management of Weight Recurrence After Sleeve Gastrectomy: A Retrospective Cohort Study

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Metabolic and bariatric surgery (MBS) is the most effective treatment for obesity and improvement of obesity-associated comorbidities. However, a proportion of these patients may suffer from weight recurrence and recurrence of obesity-associated comorbidities.

Method

A retrospective cohort study of patients who underwent SG between January 2008 and August 2022 and sought treatment for weight recurrence with semaglutide or tirzepetide from January 2022 onwards.

Result

A total of 115 patients were included, of which 70 had SG and treated for weight recurrence with semaglutide and 45 had SG and treated with tirzepatide. The mean age of patients was 38.8 (10.4) and 80.9% of patients were female. The mean pre-treatment weight and BMI was 94.0 (23.8) kg and 35.1 (6.0) kg/m2. Following treatment with semaglutide and tirzepatide, the mean post-treatment weight at 6 months was 81.0 (19.0) kg from 90.1 (19.6) kg and 87.6 (28.3) kg from 100.2 (28.5) kg respectively, corresponding to a clinically significant mean weight loss from baseline to 6 months of 10.3 (5.9)% (p < 0.05) and 15.5 (6.3)% (p < 0.05). Weight loss in tirzepatide patients was significantly greater than the semaglutide patients at 6 months (p < 0.02). There were no reported severe adverse events to the treatment.

Conclusion

Short-term outcomes show that semaglutide and tirzepatide can be an effective treatment for managing weight recurrence after SG. Studies with longer follow-up are needed to determine the durability, as weight regain after discontinuation of the medication is highly likely, and the high cost of these medications can limit their use.

Graphical Abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

The data supporting the findings of this study are available through the corresponding authors upon request.

References

  1. Torbahn G, Brauchmann J, Axon E, et al. Surgery for the treatment of obesity in children and adolescents. Cochrane Metabolic and Endocrine Disorders Group, editor. Cochrane Database Syst Rev. 2022 [cited 2024 Jan 24];2022. Available from: https://doi.wiley.com/10.1002/14651858.CD011740.pub2.

  2. Majid SF, Davis MJ, Ajmal S, et al. Current state of the definition and terminology related to weight recurrence after metabolic surgery: review by the POWER Task Force of the American Society for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022;18:957–63.

    Article  PubMed  Google Scholar 

  3.  A C, N C, A I. Postoperative morbidity and weight loss after revisional bariatric surgery for primary failed restrictive procedure: a systematic review and network meta-analysis. Int J Surg. 2022;102:106677.

  4. Lee PC, Dixon JB, Sim PY, et al. Treatment options for poor responders to bariatric surgery. Curr Obes Rep. 2020;9:364–72.

    Article  PubMed  Google Scholar 

  5. Murvelashvili N, Xie L, Schellinger JN, et al. Effectiveness of semaglutide versus liraglutide for treating post-metabolic and bariatric surgery weight recurrence. Obesity. 2023;31:1280–9.

    Article  CAS  PubMed  Google Scholar 

  6. Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375:311–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375:1834–44.

    Article  CAS  PubMed  Google Scholar 

  8. Rubino DM, Greenway FL, Khalid U, et al. Effect of weekly subcutaneous semaglutide vs daily liraglutide on body weight in adults with overweight or obesity without diabetes: the STEP 8 randomized clinical trial. JAMA. 2022;327:138.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Lautenbach A, Wernecke M, Huber TB, et al. The potential of semaglutide once-weekly in patients without type 2 diabetes with weight regain or insufficient weight loss after bariatric surgery—a retrospective analysis. Obes Surg. 2022;32:3280–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Jamal M, Qasem W, Hamshari F, et al. Effectiveness and tolerability of liraglutide for the management of weight regain following sleeve gastrectomy. Obes Sci Pract. 2024;10:e706.

    Article  PubMed  Google Scholar 

  11. Muratori F, Vignati F, Di Sacco G, et al. Efficacy of liraglutide 3.0 mg treatment on weight loss in patients with weight regain after bariatric surgery. Eat Weight Disord. 2022;27:2775–81.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Jensen AB, Renström F, Aczél S, et al. Efficacy of the glucagon-like peptide-1 receptor agonists liraglutide and semaglutide for the treatment of weight regain after bariatric surgery: a retrospective observational study. Obes Surg. 2023;33:1017–25.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bonnet J, Tournayre S, Anitcheou J, et al. Semaglutide 2.4 mg/wk for weight loss in patients with severe obesity and with or without a history of bariatric surgery. Obesity. 2024;32:50–8.

    Article  CAS  PubMed  Google Scholar 

  14. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387:205–16.

    Article  CAS  PubMed  Google Scholar 

  15. Wadden TA, Chao AM, Machineni S, et al. Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial. Nat Med. 2023;29:2909–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018;319:255.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lazzati A, Bechet S, Jouma S, et al. Revision surgery after sleeve gastrectomy: a nationwide study with 10 years of follow-up. Surg Obes Relat Dis. 2020;16:1497–504.

    Article  PubMed  Google Scholar 

  18. Jamal MH, Elabd R, AlMutairi R, et al. The safety and efficacy of one anastomosis gastric bypass as a revision for sleeve gastrectomy. Obes Surg. 2020;30:2280–4.

    Article  PubMed  Google Scholar 

  19. Hany M, Zidan A, Elmongui E, et al. Revisional Roux-en-Y gastric bypass versus revisional one-anastomosis gastric bypass after failed sleeve gastrectomy: a randomized controlled trial. Obes Surg. 2022;32:3491–503.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Vitiello A, Berardi G, Peltrini R, et al. One-anastomosis gastric bypass (OAGB) versus Roux-en-Y gastric bypass (RYGB) as revisional procedures after failed laparoscopic sleeve gastrectomy (LSG): systematic review and meta-analysis of comparative studies. Langenbecks Arch Surg. 2023;408:440.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Moon RC, Fuentes AS, Teixeira AF, et al. Conversions after sleeve gastrectomy for weight regain: to single and double anastomosis duodenal switch and gastric bypass at a single institution. Obes Surg. 2019;29:48–53.

    Article  PubMed  Google Scholar 

  22. Salama AF, Baazaoui J, Shahid F, et al. Comparative analysis of 5-year efficacy and outcomes of single anastomosis procedures as revisional surgery for weight regain following sleeve gastrectomy. Surg Endosc. 2023;37:7548–55.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Poublon N, Chidi I, Bethlehem M, et al. One anastomosis gastric bypass vs. Roux-en-Y gastric bypass, remedy for insufficient weight loss and weight regain after failed restrictive bariatric surgery. Obes Surg. 2020;30:3287–94.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wadden TA, Berkowitz RI, Womble LG, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005;353:2111–20.

    Article  CAS  PubMed  Google Scholar 

  25. Dharmaratnam VM, Lim E, Eng A, et al. Revisional surgery or pharmacotherapy for insufficient weight loss and weight regain after primary bariatric procedure: a descriptive study. Obes Surg. 2022;32:3298–304.

    Article  PubMed  Google Scholar 

  26. Wharton S, Kuk JL, Luszczynski M, et al. Liraglutide 3.0 mg for the management of insufficient weight loss or excessive weight regain post-bariatric surgery. Clin Obes. 2019;9:e12323.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mok J, Adeleke MO, Brown A, et al. Safety and efficacy of liraglutide, 3.0 mg, once daily vs placebo in patients with poor weight loss following metabolic surgery: the BARI-OPTIMISE randomized clinical trial. JAMA Surg. 2023;158:1003.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Le Roux CW, Hankosky ER, Wang D, et al. Tirzepatide 10 and 15 mg compared with semaglutide 2.4 mg for the treatment of obesity: an indirect treatment comparison. Diabetes Obes Metab. 2023;25:2626–33.

    Article  PubMed  Google Scholar 

  29. Alabduljabbar K, Le Roux CW. Pharmacotherapy before and after bariatric surgery. Metabolism. 2023;148:155692.

    Article  CAS  PubMed  Google Scholar 

  30. Ryan DH, Yockey SR. Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over. Curr Obes Rep. 2017;6:187–94.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Gallwitz B, Dagogo-Jack S, Thieu V, et al. Effect of once-weekly dulaglutide on glycated haemoglobin ( HbA1c ) and fasting blood glucose in patient subpopulations by gender, duration of diabetes and baseline HbA1c. Diabetes Obes Metab. 2018;20:409–18.

    Article  CAS  PubMed  Google Scholar 

  32. Ghusn W, De La Rosa A, Sacoto D, et al. Weight loss outcomes associated with semaglutide treatment for patients with overweight or obesity. JAMA Netw Open. 2022;5:e2231982.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA. 2021;325:1414.

    Article  CAS  PubMed  Google Scholar 

  34. Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24:1553–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA. 2024;331:38.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Organ Transplant, College of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait

    Mohammad Jamal

  2. The Clinic, Kuwait City, Kuwait

    Mohammad Jamal & Wafa Qasem

  3. Department of Surgery, Jaber Hospital, Kuwait City, Kuwait

    Mohammad Jamal, Mohsen Alhashemi, Sulaiman Almazeedi & Salman Al-Sabah

  4. Department of Surgery, College of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait

    Mohammad Jamal, Mohsen Alhashemi, Carol Dsouza & Sara Al-hassani

  5. Mubarak Hospital, Kuwait City, Kuwait

    Wafa Qasem

Authors
  1. Mohammad Jamal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohsen Alhashemi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carol Dsouza
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sara Al-hassani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wafa Qasem
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sulaiman Almazeedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Salman Al-Sabah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammad Jamal.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key Points

• This study adds to the current body of evidence supporting the clinical effectiveness of semaglutide and tirzepatide for weight reduction in patients with obesity, particularly in those with weight recurrence following sleeve gastrectomy (SG).

• Weight loss was significantly greater in the tirzepatide-treated group than the semaglutide-treated group.

• A meaningful weight loss may be achieved with the use of pharmacotherapy in patients with weight recurrence after SG without the need for revisional surgery.

• Pharmacotherapy can be an effective alternative to revisional surgeries with minimum adverse effects.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jamal, M., Alhashemi, M., Dsouza, C. et al. Semaglutide and Tirzepatide for the Management of Weight Recurrence After Sleeve Gastrectomy: A Retrospective Cohort Study. OBES SURG 34, 1324–1332 (2024). https://doi.org/10.1007/s11695-024-07137-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-024-07137-0

Keywords

Search

Navigation