A Clinical Conundrum: Prophylactic Metabolic Bariatric Surgery for People Without Obesity?

Revisional metabolic and bariatric surgery (MBS) in patients with a body mass index (BMI) below the obesity threshold (> 30 kg/m2) presents complex clinical and ethical challenges. Indications for reoperation vary widely, from acute complications like gastric band slippage to chronic metabolic disorders such as persistent hypoglycemia after Roux-en-Y gastric bypass (RYGB). While some revisional procedures, like elongation of the common limb for malabsorption-related complications, are widely accepted, other interventions remain controversial. The introduction of a distinct ICD code could help classify MBS-related complications and support surgical decision-making independent of BMI. Additionally, the role of obesity management medications (OMMs) complicates the landscape, as their discontinuation often leads to weight regain. The prophylactic use of MBS to prevent future weight gain is highly debated and risks expanding surgical indications inappropriately. Establishing clear guidelines for revisional surgery in non-obese patients with complications is crucial to ensure justified and effective interventions.