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New concepts and clinical significance of outcome assessment for revisional metabolic and bariatric surgery
ZHANG Hong-wei, ZHANG Pin
Chinese Journal of Practical Surgery ›› 2026, Vol. 46 ›› Issue (9) : 1199-1203.
PDF(1335 KB)
PDF(1335 KB)
New concepts and clinical significance of outcome assessment for revisional metabolic and bariatric surgery
Revisional metabolic and bariatric surgery (RBS) is an important clinical intervention after an unsatisfactory outcome of primary bariatric surgery or the occurrence of serious complications.The reasons for revision and the therapeutic goals are highly heterogeneous. Conventional outcome assessment based solely on the magnitude of weight loss no longer meets diverse clinical diagnosis and treatment needs. An objective appraisal of the clinical value of RBS must begin by identifying the specific reason for revision. For inadequate weight loss or weight regain, refractory gastroesophageal reflux disease, dysphagia, gastrointestinal leak or fistula, severe malnutrition, and other revisional indications, core outcomes should be defined individually rather than judged against a single absolute threshold for success. A systematic, multidimensional framework should encompass weight control, outcomes in obesity-related comorbidities, perioperative safety, long-term nutritional status, the rate of reintervention, and health-related quality of life. The type of revisional procedure and the concomitant use of weight-loss medication, endoscopic therapy, and intensive lifestyle intervention should also be documented in a standardized manner to distinguish the contribution of surgery itself from that of comprehensive treatment. The time origin for weight-related follow-up should be standardized: the additional weight-loss effect should be calculated from body weight before revision, whereas the cumulative weight-loss effect should be calculated from body weight before the primary procedure. Clinical registries and research reports should fully report key weight parameters, the actual number of patients assessed at each follow-up point, and reasons for loss to follow-up to reduce selective reporting and attrition bias. Establishing standardized follow-up for more than 5 years, together with a multidisciplinary collaborative comprehensive management model, can facilitate the integration of RBS into life-course management pathway for patients with obesity.
metabolic and bariatric surgery / revisional surgery / outcome assessment / life-course management / follow-up
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中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和代谢病外科专家工作组. 中国肥胖及代谢疾病外科治疗指南(2024版)[J]. 中国实用外科杂志, 2024, 44(8):841-849.DOI:10.19538/j.cjps.issn1005-2208.2024.08.01.
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邵怡凯, 姚琪远. 肥胖病人胃食管反流病治疗[J]. 中国实用外科杂志, 2019, 39(4):328-331.DOI:10.19538/j.cjps.issn1005-2208.2019.04.07.
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Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed metabolic and bariatric surgeries (MBS) worldwide due to its simplicity and efficacy. However, long-term outcomes have revealed limitations, including recurrent weight regain, inadequate weight loss, and nutritional deficiencies, leading to an increasing need for revisional bariatric surgery. While revisional procedures can restore weight loss efficacy, they may also carry additional risks of micronutrient and protein deficiencies due to anatomical and physiological alterations.
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Despite the current increase in revisional bariatric surgery (RBS), data on the sustainability of weight loss remain unclear. A systematic review and meta-analysis were performed to assess weight loss outcomes in adult patients undergoing RBS with follow-up > 2 years. Twenty-eight observational studies (n = 2213 patients) were included. The %TWL was 27.2 (95%CI = 23.7 to 30.6), and there was a drop in BMI of 10.2 kg/m (95%CI = - 11.6 to - 8.7). The %EWL was 54.8 (95%CI = 47.2 to 62.4) but with a high risk of publication bias (Egger's test = 0.003). The overall quality of evidence was very low. Our data reinforce that current evidence on RBS is mainly based on low-quality observational studies, and further higher-quality studies are needed to support evidence-based practice.© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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国家卫生健康委员会办公厅. 肥胖症诊疗指南(2024年版)[EB/OL]. (2024-10-17)[2026-08-02]. https://www.nhc.gov.cn/wjw/c100378/202410/bcf804e19e0c4246b5aea6cd338b55e1/files/1732873189749_61795.pdf.
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This survey of international experts in obesity management was conducted to achieve consensus on standardized definitions and to identify areas of consensus and non-consensus in metabolic bariatric surgery (MBS) to assist in an algorithm of clinical practice guidelines for the management of obesity.A three-round Delphi survey with 136 statements was conducted by 43 experts in obesity management comprising 26 bariatric surgeons, 4 endoscopists, 8 endocrinologists, 2 nutritionists, 2 counsellors, an internist, and a pediatrician spanning six continents over a 2-day meeting in Hamburg, Germany. To reduce bias, voting was unanimous, and the statements were neither favorable nor unfavorable to the issue voted or evenly balanced between favorable and unfavorable. Consensus was defined as ≥ 70% inter-voter agreement.Consensus was reached on all 15 essential definitional and reporting statements, including initial suboptimal clinical response, baseline weight, recurrent weight gain, conversion, and revision surgery. Consensus was reached on 95/121 statements on the type of surgical procedures favoring Roux-en-Y gastric bypass, sleeve gastrectomy, and endoscopic sleeve gastroplasty. Moderate consensus was reached for sleeve gastrectomy single-anastomosis duodenoileostomy and none on the role of intra-gastric balloons. Consensus was reached for MBS in patients > 65 and < 18 years old, with a BMI > 50 kg/m, and with various obesity-related complications such as type 2 diabetes, liver, and kidney disease.In this survey of 43 multi-disciplinary experts, consensus was reached on standardized definitions and reporting standards applicable to the whole medical community. An algorithm for treating patients with obesity was explored utilizing a thoughtful multimodal approach.© 2023. The Author(s).
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中国医师协会外科医师分会肥胖代谢外科综合管理及护理支持学组. 减重代谢手术后随访管理专家共识(2025版)[J]. 中华消化外科杂志, 2025, 24(8):934-942.DOI:10.3760/cma.j.cn115610-20250623-00443.
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Weight non-response after sleeve gastrectomy is an emerging issue. This systematic review compared revisional procedures for weight-related outcomes. We searched several databases for relevant articles and included adult patients with revisional bariatric procedures after primary sleeve gastrectomy. Twelve trials with 1046 patients were included, covering five revisional procedures. There were no randomised controlled trials, and 10 studies had a critical risk of bias. Significant variations in inclusion criteria, therapy benchmarks, follow-up schemes, and outcome measurements were observed, preventing meaningful comparison of results. Evidence-based treatment strategies for weight non-response after sleeve gastrectomy cannot be deduced from the current literature. Prospective studies with well-defined indications, standardised techniques, and strict adherence to outcome measurements are needed.
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顾岩, 张丰, 杨建军, 等. 青少年减重代谢手术失败的处理原则[J]. 中国实用外科杂志, 2025, 45(10):1116-1120.DOI:10.19538/j.cjps.issn1005-2208.2025.10.08.
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Suboptimal initial clinical response (SICR) and weight gain recurrence (WGR) are challenging issues following bariatric surgery. Recently, the promising weight loss effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been applied to bariatric patients. We aimed to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of GLP-1 RAs in the treatment of SICR and WGR after bariatric surgery.A literature search was performed across online databases. The primary outcomes were percentage of total weight loss (%TWL) and absolute weight loss. Secondary outcomes included changes in biochemical markers and adverse effects (AEs).Nineteen studies including 1290 patients were included. After at least 3 months of treatment, the pooled %TWL was 9.24% for liraglutide, 11.38% for semaglutide, and 15.50% for tirzepatide, with corresponding weight reductions of 8.56 kg, 11.62 kg, and 12.60 kg, respectively. Additionally, %TWL and weight loss with liraglutide use were 7.65% and 7.47 kg for ≤ 6 months, 10.22% and 9.30 kg for 6-12 months, and 10.80% and 9.72 kg for ≥ 12 months. For semaglutide, the %TWL and weight reduction were 10.18% and 9.43 kg at 6 months, and 13.15% and 14.68 kg at 12 months. Biochemical markers including triglycerides, total cholesterol, low-density lipoprotein cholesterol, glycated hemoglobin, and alanine aminotransferase levels showed significant reductions after GLP-1 RA treatment. Common AEs were nausea (23%), vomiting (6%), diarrhea (6%), constipation (10%), headache (6%), fatigue (8%), abdominal pain (2%), and abdominal bloating (2%). The proportion of patients who discontinued the treatment due to AEs was 3%.GLP-1 RAs are effective and safe for treating SICR and WGR after bariatric surgery.© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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The focus of measuring success in obesity treatment is shifting from weight loss to patients' health and quality of life. The objective of this study was to select a core set of patient-reported outcomes and patient-reported outcome measures to be used in clinical obesity care.The Standardizing Quality of Life in Obesity Treatment III, face-to-face hybrid consensus meeting, including people living with obesity as well as healthcare providers, was held in Maastricht, the Netherlands, in 2022. It was preceded by two prior multinational consensus meetings and a systematic review.The meeting was attended by 27 participants, representing twelve countries from five continents. The participants included healthcare providers, such as surgeons, endocrinologists, dietitians, psychologists, researchers, and people living with obesity, most of whom were involved in patient representative networks. Three patient-reported outcome measures (patient-reported outcomes) were selected: the Impact of Weight on Quality of Life-Lite (self-esteem) measure, the BODY-Q (physical function, physical symptoms, psychological function, social function, eating behavior, and body image), and the Quality of Life for Obesity Surgery questionnaire (excess skin). No patient-reported outcome measure was selected for stigma.A core set of patient-reported outcomes and patient-reported outcome measures for measuring quality of life in clinical obesity care is established incorporating patients' and experts' opinions. This set should be used as a minimum for measuring quality of life in routine clinical practice. It is essential that individual patient-reported outcome measure scores are shared with people living with obesity in order to enhance patient engagement and shared decision-making.© 2024. The Author(s).
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Sleeve gastrectomy (SG) is the most performed bariatric surgery worldwide. However, this surgery may be associated with long-term weight regain and severe gastroesophageal reflux disease (GERD), sometimes necessitating conversion to Roux-en-Y gastric bypass (RYGB) to improve quality of life (QoL). We conducted a systematic review on QoL measures following the conversion of SG to RYGB. We searched various databases for studies conducted between January 2005 and September 2023. Four studies, involving 196 participants in total, met the inclusion criteria. Different assessment methods were used to evaluate QoL following the conversion. In the included studies, we observed that GERD symptoms and proton pump inhibitor (PPI) use both decreased following conversion to RYGB. Excess weight loss (EWL) was also observed in all studies.© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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邱凤仪, 吴丹, 杨华, 等. 减重手术后病人健康相关生活质量评估工具的研究进展[J/CD]. 中华肥胖与代谢病电子杂志, 2023, 9(4):293-298.DOI:10.3877/cma.j.issn.2095-9605.2023.04.011.
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Revisional bariatric surgery after an index adjustable gastric band (AGB) may be indicated to remedy weight relapse or band-related complications. We examined outcomes five years following revision from AGB to laparoscopic sleeve gastrectomy (AGB-LSG) or to Roux-en-Y gastric bypass (AGB-RYGB).We conducted a retrospective review to identify patients (men and women, age 18-80) who underwent one revisional bariatric procedure with AGB as the index procedure at two medical centers in our healthcare system between January 2012 and February 2017. We only included patients with a pre-revision BMI > 30 kg/m for whom 5-year follow-up data were available. We compared 5-year weight loss and remission of comorbidities in patients undergoing AGB-LSG and AGB-RYGB conversion.A total of 114 patients met inclusion criteria (65 AGB-LSG, 49 AGB-RYGB). At 5-year post-revision, percent total weight loss (3.4% vs 19.9%; p < 0.001), percent excess weight loss (7.0% vs 50.8%; p < 0.001) and decrease in BMI (1.5 vs 8.8; p < 0.001) was greater in AGB-RYGB vs. AGB-LSG. No significant difference in remission or development of new comorbidities was observed.Conversion of AGB to RYGB is associated with superior intermediate-term weight loss compared to conversion of AGB to LSG. Future multicenter studies with larger sample sizes are necessary to further describe the intermediate-term outcomes of revisional bariatric surgery.© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会肥胖代谢外科综合管理专家工作组, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库:2023年度报告[J/CD]. 中华肥胖与代谢病电子杂志, 2024, 10(2):73-83.DOI:10.3877/cma.j.issn.2095-9605.2024.02.001.
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中国营养学会肥胖防控分会, 中国营养学会临床营养分会, 中华预防医学会行为健康分会, 等. 中国居民肥胖防治专家共识[J]. 中华流行病学杂志, 2022, 43(5):609-626.DOI:10.3760/cma.j.cn112338-20220402-00253.
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