The impact of semaglutide initiated six months after laparoscopic sleeve gastrectomy on long-term weight loss and metabolic outcomes: single-center preliminary study

BACKGROUND: Although laparoscopic sleeve gastrectomy (LSG) is an effective treatment for severe obesity, some patients experience suboptimal weight loss or an early weight-loss plateau during postoperative follow-up. Semaglutide has emerged as an effective pharmacological option for obesity management; however, evidence regarding its use after bariatric surgery remains limited. This study evaluated the impact of adjunctive semaglutide therapy initiated six months after LSG on long-term weight loss and metabolic outcomes. MATERIALS AND METHODS: This retrospective single-center study included 88 patients who underwent primary LSG. Patients were divided into two groups: 45 patients underwent standard postoperative follow-up after LSG, whereas 43 patients received adjunctive semaglutide therapy initiated six months after surgery because of suboptimal weight loss or weight-loss plateau. Anthropometric and metabolic parameters, including body weight, body mass index (BMI), percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), glycated hemoglobin (HbA1c), lipid profile, and blood pressure, were evaluated at baseline and at 6, 12, and 24 months after surgery. RESULTS: No significant differences were observed between the groups six months after surgery, immediately before semaglutide initiation. At 12 months, patients receiving semaglutide achieved significantly lower BMI, lower body weight, and greater %TWL and %EWL. These benefits persisted at 24 months, with significantly greater weight loss and a more favorable metabolic profile, including higher HDL cholesterol and lower total cholesterol and triglyceride concentrations. CONCLUSIONS: Adjunctive semaglutide therapy initiated six months after laparoscopic sleeve gastrectomy was associated with significantly greater long-term weight loss and improved cardiometabolic outcomes compared with surgery alone. These findings suggest that postoperative semaglutide may represent an effective and safe strategy for patients experiencing suboptimal weight loss following sleeve gastrectomy.