Efficacy and Safety of Bariatric Surgery in Acquired Hypothalamic Obesity: A Systematic Review and Individual Patient Data Meta-Analysis

Objective: This work aimed to investigate the efficacy and safety of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in adults with acquired hypothalamic obesity (HO). Design: Systematic review and meta-analysis. Methods: Publications reporting relevant outcomes in patients with HO before and after RYGB or SG were identified through a systematic literature search. Two meta-analyses were performed: one based on individual patient data (IPD) and one on case–control studies. Results: Thirteen publications including 36 unique patients with HO were included in the IPD meta-analysis. Percent total weight loss was 16.5% (95% CI, 11.6%–21.4%; p = 5.7 × 10⁻⁸) after a median follow-up of 31.5 months (IQR 24.0, 60.0). Weight loss after RYGB was slightly but not significantly larger compared with SG (17.4% vs. 15.2%). Type and rate of adverse events were reported to be as expected, and no major concerns were raised regarding hormone replacement therapy (HRT). Four publications including 49 patients with HO and 223 patients with common obesity were included in the case–control meta-analysis that showed a 12.5%-point lower weight loss in cases compared with controls with no major differences in the safety profile of the surgical procedures. Conclusions: Bariatric surgery in patients with acquired HO induces a clinically meaningful weight loss sustained for at least 2.5 years and appears to be safe. No significant differences were observed between RYGB and SG, but weight loss is substantially lower in patients with HO compared with patients with common obesity. However, the limited evidence calls for close surveillance if bariatric surgery is more widely adopted in this group of patients.