A multidisciplinary approach for non-responders after bariatric surgery: why does it matter?

Abstract Background: 20-30% of patients show a lack of response after bariatric surgery. These non-responders may experience insufficient weight loss or significant weight regain. While ongoing studies about the beneficial effect of revisional surgery on non-response are being reported, studies about the contributiveness of a multidisciplinary approach fall behind. The aim of this study was to describe the effect of a multidisciplinary approach on treatment strategy in non-responders after gastric bypass and sleeve gastrectomy.Methods: this retrospective study included non-responders that were reviewed in a multidisciplinary team meeting. Outcomes assessed were: given treatment (conservative versus operative), weight loss and complications after operative treatment. Outcomes were described separately for primary non- responders and secondary non-responders.Results: a total of 104 patients were included (n=15 primary, n=89 secondary non-response). Eleven patients underwent revisional surgery (13%), while 73 patients received conservative treatment as they were not eligible for surgery due to lifestyle and/or behavioural factors. Twenty patients did not show up at their appointment with the dietician, physical therapist and/or medical psychologist and were excluded from further analysis. Conservatively treated patients lost 2.1kg <12 months (SD=7.29) and 0.8kg <24 months (SD=5.08). Surgically treated patients lost 12.0kg <12 months (SD=4.29) and 26.3kg <24 months (SD=2.75). One complication occurred in a patient that underwent revisional surgery.Conclusions: a conservative treatment was more frequently proposed by the multidisciplinary team than a surgical treatment. A multidisciplinary approach can be beneficial for the identification of lifestyle and/or behavioural factors contributing to the development of non-response. More studies would help to establish the position of a multidisciplinary approach in the treatment of non-responders in future practices.