Weigh regain after bariatric surgery is a complex and multifactorial process which needs careful consideration. It can be related to the failure of the primary procedure, non compliance of the patient or other factors.. Weight regain is defined as regain of more than 20% of the excess weight which was lost initially after undergoing a bariatric surgery. It can happen in 5-10% of the patients undergoing bariatric surgery. It most commonly starts after 2-3 years of the primary procedure and is more commonly seen in restrictive than malabsorptive procedures.
In case of procedure related factors, it can be because of slippage of a band/ring in gastric banding , stretching and dilation of the remnant stomach in sleeve gastrectomy or suture breakage/loosening in gastric plication. In all these cases, the patient would experience a loss of restriction and increased appetite and capacity to take food. This leads to caloric surplus and weight gain.
In some cases, it may be the result of dietary non compliance by the patient and overall poor lifestyle which results in weight regain. Patients with poor self control, high stress jobs with untimely schedules and those with sweet cravings and alcohol addiction are more likely to cheat the surgery and regain weight in the long term. Patients who have undergone personal trauma or the victims of depression may suffer weight regain.
Other cases of weight regain may not have any specified factors and are attributed to metabolic changes and the waning effect of bariatric surgery to regulate weight over time. The treatment of weight regain should be tailored to the patient and its cause determined. A combination of diet modification, lifestyle s changes and psychological therapy should help. Some cases may benefit from revisional surgery.