Bariatric Bypass Surgery to Resolve Complicated Childhood Morbid Obesity (original) (raw)
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Bariatric Surgery in Adolescents: To Do or Not to Do?
Children
Pediatric obesity is a multifaceted disease that can impact physical and mental health. It is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors. In most cases lifestyle and behavioral modification as well as medical treatment led to poor short-term weight reduction and long-term failure. Thus, bariatric surgery should be considered in adolescents with moderate to severe obesity who have previously participated in lifestyle interventions with unsuccessful outcomes. In particular, laparoscopic sleeve gastrectomy is considered the most commonly performed bariatric surgery worldwide. The procedure is safe and feasible. The efficacy of this weight loss surgical procedure has been demonstrated in pediatric age. Nevertheless, there are barriers at the patient, provider, and health system levels, to be removed. First and foremost, more efforts must be made to prevent decline in nutritional status that is frequent after bariatric s...
Pediatric bariatric surgery: the clinical pathway
PURPOSE: Despite the rising interest in bariatric surgery (BS) for children and adolescents, algorithms that incorporate BS in weight management (WM) programs are lacking. This study presents the results of the pediatric bariatric surgery clinical pathway employed in our institution. MATERIALS AND METHODS: Starting March 2008, we enrolled obese children and adolescents in a standardized multidisciplinary obesity management program. Weight loss, complications, comorbidities, and growth results of those who eventually underwent BS were compared with a matched (age, gender, and height z-score) group of patients on non-surgical WM only. RESULTS: Up to July 2014, a total of 659 patients received care through the pathway, of whom 291 patients underwent laparoscopic sleeve gastrectomy (LSG). Mean age and pre-LSG body mass index (BMI) were 14.4 ± 4.0 years (range; 5 to 21 years) and 48.3 ± 10.0 (range; 31.8-109.6). Mean BMI change (% excess weight loss) at 1, 2, 3, and 4 postoperative years was -16.9 ± 4.9 (56.6 ± 22.6), -17.5 ± 5.2 (69.8 ± 22.5), -18.9 ± 4.3 (75.1 ± 26.8), and -19.6 ± 6.4 (73.6 ± 24.3), respectively. Postoperatively, complications occurred in 12 patients (4.1%), with no leaks or mortality, and more than 90% of comorbidities were resolved or improved without recurrence. Additionally, LSG patients exhibited significantly higher postoperative growth velocity compared to WM patients. CONCLUSIONS: Applying this standardized clinical pathway with its BS component results in safe and successful weight loss for pediatric patients, with low complication rates, maximum comorbidity resolution, and minimum morbidity.
Laparoscopic Sleeve Gastrectomy in 108 Obese Children and Adolescents Aged 5 to 21 Years
Objective: To report experience with laparoscopic sleeve gastrectomy (LSG) in 108 severely obese children and adolescents. Background: Obesity during childhood and adolescence can be accompanied by serious long-term adverse health and longevity outcomes. With increased use of bariatric surgery to treat obesity in these patients, diverse guidelines have been published, most of which exclude children aged younger than 14 years. Few reports describe LSG in children and adolescents, delaying determining its safety and effectiveness and developing guidance regarding its use. Methods: A retrospective review of LSG performed from March 2008 through February 2011 by a single surgeon at King Saud University Hospitals, Riyadh, Saudi Arabia, included 108 patients aged 5 through 21 years. Results: Patients attending follow-up visits at 3 (n = 88), 6 (n = 76), 12 (n = 41), and 24 (n = 8) months postoperatively experienced median excess weight loss (EWL) of 28.9%, 48.1%, 61.3%, and 62.3%, respectively. At 6 and 12 months follow-up, 42.1% (n = 32) and 73.2% (n = 30) of patients achieved at least 50% EWL, whereas 7.9% (n = 6) and 4.9% (n = 2) had 25% or less EWL, respectively. There were no serious postoperative complications and no adverse sequelae developed during the current follow-up. Available comorbidity data indicate resolution of dyslipidemia, 21 of 30 (70.0%); hypertension, 27 of 36 (75.0%); prehypertension, 15 of 18 (83.3%); symptoms of obstructive sleep apnea, 20 of 22 (90.9%); diabetes, 15 of 16 (93.8%); and prediabetes, 11 of 11 (100.0%). Conclusions: LSG resulted in successful short-term weight loss in more than 90% of pediatric patients and 70% or more comorbidity resolution during up to 24 months of follow-up. Long-term data are necessary to evaluate persistence of weight loss and maturation to adulthood. (Ann Surg 2012;00:1-8)
Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity
Pediatrics, 2019
Severe obesity affects the health and well-being of millions of children and adolescents in the United States and is widely considered to be an “epidemic within an epidemic” that poses a major public health crisis. Currently, few effective treatments for severe obesity exist. Metabolic and bariatric surgery are existing but underuse treatment options for pediatric patients with severe obesity. Roux-en-Y gastric bypass and vertical sleeve gastrectomy are the most commonly performed metabolic and bariatric procedures in the United States and have been shown to result in sustained short-, mid-, and long-term weight loss, with associated resolution of multiple obesity-related comorbid diseases. Substantial evidence supports the safety and effectiveness of surgical weight loss for children and adolescents, and robust best practice guidelines for these procedures exist.
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 2017
Introduction Childhood obesity is an emerging health problem. Surgical treatment of obese adolescents, particularly those affected by congenital syndrome, represents a controversial issue. The aim of this multicenter study was to retrospectively assess the results of laparoscopic sleeve gastrectomy (LSG) in a cohort of adolescents affected by morbid obesity, with or without congenital syndromes. Materials and methods Forty-one obese (BMI 49 ± 6 kg/ m 2) adolescents with mean age of 16 ± 3 years (58.5% with previous intragastric balloon failure), and subjected to LSG, were retrospectively evaluated for complications rate, % excess weight loss (%EWL), and inhibition of comorbidities after 2 years of follow-up. Results All the operations were completed laparoscopically and no intra-operative complications were recorded. No mortality was recorded while peri-or post-operative complications only occurred in two patients (4.9%). The EWL% at 6, 12, and 24 months were 42.3, 58.3, and 59.4, respectively. %EWL was comparable (p = 0.7) between non-syndromic and syndromic obese adolescents at 24 months. Conversely patients with previous intragastric balloon surgery had a significant lower EWL (%) at 24 month (p \ 0.01). Moreover, at the same time point, comorbidity resolution rate was 78.2% while improvement rate was 57.6%. Specifically, remission rate of type 2 diabetes (T2DM), hypertension and obstructive sleep apnea (OSA) were 71, 75 and 61%, respectively. Conclusion LSG is advantageous in the treatment of morbidly obese juveniles concerning safety, weight loss and co-morbidity control and at same time presenting, a possible effective therapeutic option for patients affected by congenital syndrome.
Evolution and Outcomes of a Canadian Pediatric Bariatric Surgery Program
Journal of Pediatric Surgery, 2019
An interdisciplinary obesity management program was established in 2007 at our quaternary hospital, including bariatric surgery for selected adolescent patients. We report the evolution of surgical management within the program and outcomes following bariatric surgery. Methods: This was a retrospective review of adolescents who underwent bariatric surgery between 2007 and 2017. All cases were performed by a pediatric surgeon and an adult bariatric surgeon. Baseline demographics, BMI, co-morbidities, and post-operative outcomes were recorded. Results: Thirty-eight patients underwent bariatric surgery. Median age at entrance into the program was 16.5 (range, 12.1-17.4) years and at time of surgery was 17.4 (range, 13.6-18.8) years. Eight patients had laparoscopic adjustable gastric banding (LAGB) from 2007 to 10. Between 2011 and 2017, 18 had laparoscopic sleeve gastrectomy (LSG), and 12 had laparoscopic Roux-en-Y gastric bypass (RYGB). There were no intraoperative complications or conversions. Postoperative complications included wound infection, bleeding requiring transfusion and re-exploration, and internal hernia. Of patients who had LAGB, 2 required surgical revision, and 3 underwent subsequent removal. Conclusions: Adolescent bariatric surgery in the context of a multidisciplinary obesity management program is safe and effective. RYGB and sleeve gastrectomy are associated with superior weight loss in the immediate postoperative period and at most recent follow-up and lower reoperation rates than gastric banding. Level of Evidence: III.
Role of Bariatric Surgery in Paediatric Obesity
JOURNAL OF SURGERY AND ANESTHESIA, 2023
Childhood obesity has become an alarming global health issue. Among the various therapeutic strategies, surgery is progressively being recognized as a potent intervention for children and adolescents with severe and morbid obesity, typically those unresponsive to conventional treatments. This review investigates the role of surgery in the management of pediatric obesity, discussing the classification of obesity severity, the indications for surgery, and the different surgical procedures available. Each surgical technique's advantages and disadvantages are explored, alongside the rigorous preoperative investigations required. The review's objective is to provide a comprehensive understanding of the surgical approaches for pediatric obesity, further emphasizing the necessity for personalized treatment strategies for optimal outcomes.
Laparoscopic sleeve gastrectomy for a two-and half year old morbidly obese child
International Journal of Surgery Case Reports, 2013
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is an accepted technique in bariatric surgery for reducing obesity. Recent reports indicate it to be effective even in children but it has not been tried in very young children. PRESENTATION OF CASE: We report here a case of a 2 and half years old child subjected to LSG for his morbid obesity and associated obstructive sleep apnea and bowing of legs. LSG was performed after investigations ruled out hereditary or genetic causes of obesity. The procedure was well tolerated without any complications and 2 months post surgery, the obstructive sleep apnea decreased substantially. The child was followed up for two years. At the last follow up BMI was drastically reduced from a pre surgical value of 41.1-24 kg/m 2 at 24 months post surgery. DISCUSSION: Prior to our report the youngest child to undergo sleeve gastrectomy was 5 years old from Saudi Arabia. We observed LSG to be safe and effective in reducing obesity and related co morbidities in a two and half year's old child. CONCLUSION: The results suggest that LSG can be a safe and effective alternative for weight control in morbidly obese children even of less than 3 years of age. However more studies and long term follow up is essential for monitoring the growth and development of children subjected to LSG.
Bariatric surgery for severely obese adolescents
Journal of Gastrointestinal Surgery, 2003
A 1991 National Institutes of Health Consensus Conference concluded that severely obese adults could be eligible for bariatric surgery if they had a body mass index (BMI) ≥35 kg/m2 with or ≥40 kg/m2 without obesity comorbidity. It was thought at that time that there were inadequate data to support bariatric surgery in severely obese adolescents. An estimated 25% of children in the United States are obese, a number that has doubled over a 30-year period. Very little information has been published on the subject of obesity surgery in adolescents. Therefore we reviewed our 20-year database on bariatric surgery in adolescents. Severely obese adolescents, ranging from 12 to less than 18 years of age, were considered eligible for bariatric surgery according to the National Institutes of Health adult criteria. Gastroplasty was the procedure of choice in the initial 3 years of the study followed by gastric bypass, which was found to be significantly more effective for weight loss in adults. Distal gastric bypass (D-GBP) was used in extremely obese patients (BMI ≥60 kg/m2) before 1992 and long-limb gastric bypass (LL-GBP) was used for super-obese patients (BMI ≥50 kg/m2) after 1992. Laparoscopic gastric bypass was used after 2000. Thirty-three adolescents (27 white, 6 black; 19 females, 14 males) underwent the following bariatric operations between 1981 and June 2001: horizontal gastroplasty in one, vertical banded gastroplasty in two, standard gastric bypass in 17 (2 laparoscopic), LL-GBP in 10, and D-GBP in three. Mean BMI was 52 ±11 kg/m2 (range 38 to 91 kg/m2), and mean age was 16 ± 1 years (range 12.4 to 17.9 years). Preoperative comorbid conditions included the following: type II diabetes mellitus in two patients, hypertension in 11, pseudotumor cerebri in three, gastroesophageal reflux in five, sleep apnea in six, urinary incontinence in two, polycystic ovary syndrome in one, asthma in one, and degenerative joint disease in 11. There were no operative deaths or anastomotic leaks. Early complications included pulmonary embolism in one patient, major wound infection in one, minor wound infections in four, stomal stenoses (endoscopically dilated) in three, and marginal ulcers (medically treated) in four. Late complications included small bowel obstruction in one and incisional hernias in six patients. There were two late sudden deaths (2 years and 6 years postop-eratively), but these were unlikely to have been caused by the bariatric surgical procedure. Revision procedures included one D-GBP to gastric bypass for malnutrition and one gastric bypass to LL-GBP for inadequate weight loss. Regain of most or all of the lost weight was seen in five patients at 5 to 10 years after surgery; however, significant weight loss was maintained in the remaining patients for up to 14 years after surgery. Comorbid conditions resolved at 1 year with the exception of hypertension in two patients, gastroesophageal reflux in two, and degenerative joint disease in seven. Self-image was greatly enhanced; eight patients have married and have children, five patients have completed college, and one patient is currently in college. Severe obesity is increasing rapidly in adolescents and is associated with significant comorbidity and social stigmatization. Bariatric surgery in adolescents is safe and is associated with significant weight loss, correction of obesity comorbidity, and improved self-image and socialization. These data strongly support obesity surgery for those unfortunate individuals who may have difficulty obtaining insurance coverage based on the 1991 National Institutes of Health Consensus Conference statement.
Co-morbidity resolution in morbidly obese children and adolescents undergoing sleeve gastrectomy
Background: Bariatric surgery is becoming important for the reversal of co-morbidities in children and adolescents. We previously reported the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in the pediatric population. However, evidence pertaining to the effect of LSG on co-morbidities in this age group is scarce. The objective of this study was to assess the remission and improvement of co-morbidities (dyslipidemia, hypertension, diabetes, and obstructive sleep apnea) after LSG in children and adolescents. Methods: Anthropometric changes, complications, remission, and improvement in co-morbidities were assessed over 3 years. OSA was diagnosed using the Pediatric Sleep Questionnaire (PSQ) and polysomnography and its resolution was assessed according to PSQ score alone. Diabetes, prediabetes, hypertension, prehypertension, and dyslipidemia were assessed using standard pediatric-specific definitions. Results: The review yielded 226 patients; 74 patients were prepubertal (5-12 yr of age, mean: 9.8±2.3), 115 adolescents (13-17 yr of age, mean: 15.4±1.7), and 37 were young adults (18-21 yr of age, mean: 19.2±.8). Overall mean age was 14.4±4.0 years (range: 4.94-20.99), and 50.4% were females. Mean body mass index (BMI) and BMI z score were 48.2±10.1 kg/m(2) and 2.99±.35, respectively. Mean BMI z score at 1, 2, and 3 years postoperative was 2.01±.87, 2.00±1.07, and 1.66±.65, respectively. Mean preoperative height was 158.0±15.1 cm, and at 1, 2, and 3 years postoperative, it was 160.3±13.4, 161.4±14.1, and 163.2±11.1, respectively. All patients at different age groups experienced normal growth velocity. Within 2 years of follow-up, 90.3% of co-morbidities were in remission or improved, 64.9% of which were within the first 3 months postoperatively. No further improvement or remission was observed beyond 2 years, and there was no recurrence up to 3 years in patients who were seen in follow-up. The lost to follow-up in each of the 3 years was 4.2%, 7.6%, and 15.3%, respectively. Conclusion: LSG performed on children and adolescents results in remission or improvement of>90% of co-morbidities within 2 years after bariatric surgery with few complications, no mortality, and normal growth.