Abstract
PURPOSE: Sleeve gastrectomy (LSG) is effective, but weight regain (WR) and variable hormonal responses challenge long-term outcomes. This study evaluated long-term weight and incretin trajectories after LSG in adolescents and assessed the impact of adjunct semaglutide therapy for patients with WR. MATERIALS AND METHODS: A retrospective cohort of 264 adolescents (mean age 15 ± 3 years; 74% female) underwent standardized LSG and was followed for five years with annual measurements of weight, BMI, %TWL, %EWL, GLP-1 and GIP. WR was defined as ≥ 10% gain from nadir plus < 50% excess weight loss at 18 months. Patients meeting these criteria (n = 62) received semaglutide from postoperative year 3. RESULTS: Mean weight dropped from 133 to 87 kg by year 2, with %EWL peaking at 68% and declining to 63% by year 5. GLP-1 and GIP levels rose in the first postoperative year and diminished thereafter. Adolescents with WR exhibited more pronounced attenuation of incretin responses and larger gastric volumes than those without WR. Semaglutide increased mean %EWL in WR patients from 34 to 68% by year 3. Metabolic comorbidities improved across the cohort. CONCLUSIONS: LSG produces sustained weight loss and metabolic benefits in adolescents. Incretin surges attenuate over time, particularly among those experiencing WR. A one-year course of semaglutide partially reversed WR, suggesting a potential adjunctive role for GLP-1 agonists in selected patients. Early hormonal differences warrant prospective research to clarify predictive value for weight regain.