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Outcomes of bariatric surgery in the young: a single-institution experience caring for patients under 21 years old

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Abstract

Background

Medical weight loss options are rarely successful long term in young patients. Bariatric surgery has been shown to be safe and effective in this population.

Methods

Patients ≤21 years old who had bariatric surgery at our institution between January 2009 and December 2013 were evaluated to determine the safety and efficacy of bariatric surgery in this population. The primary end point was excess weight loss (EWL). Secondary end points included surgical morbidity, improvement in obesity-related metabolic parameters, and subjective obesity-related symptoms at 1 year.

Results

Fifty-four patients were identified who had a laparoscopic Roux-en-Y gastric bypass (LGBP) or laparoscopic sleeve gastrectomy (LSG). Fourteen patients were male (25.9 %), and 40 patients were female (74.1 %). Thirty-seven patients (68.5 %) underwent LGBP, and 17 patients (31.5 %) underwent LSG. Median follow-up was 13.3 months. The baseline BMI was 51.7 kg/m2 for the LGBP group and 51.0 kg/m2 for the LSG group. EWL was 35.2, 47.6, 62.4, 58.1, and 61.8 % for the LGBP group; 29.7, 44.7, 57.4, 60.3, and 59.0 % for the LSG group at 3, 6, 12, 24, and 36 months, respectively. Our complications included 1 anastomotic bleed, 1 postoperative stricture, and 1 patient who developed vitamin deficiency that manifested as a peripheral neuropathy in the LGBP group. LGBP was more successful than LSG in improving lipid panel parameters and HbA1c at 1 year, and it also seemed to offer better subjective improvement in obesity-related symptoms.

Conclusions

LGBP and LSG seem to confer comparable weight loss benefit in patients ≤21 years old with acceptable surgical morbidity.

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Abbreviations

BMI:

Body mass index

EWL:

Estimated weight loss

LSG:

Laparoscopic sleeve gastrectomy

LGBP:

Laparoscopic Roux-en-Y gastric bypass

HTN:

Hypertension

DM:

Diabetes mellitus

HL:

Hyperlipidemia

OSA:

Obstructive sleep apnea

DVT:

Deep vein thrombosis

PE:

Pulmonary embolism

PCOS:

Polycystic ovarian syndrome

References

  1. Skelton JA, Cook SR, Auinger P, Klein JD, Barlow SE (2009) Prevalence and trends of severe obesity among US children and adolescents. Acad Pediatr 9(5):322–329

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, Urbina EM, Ewing LJ, Daniels SR (2013) Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 128(15):1689–1712

    Article  PubMed  Google Scholar 

  3. Ogden CL, Carroll MD, Kit BK, Flegal KM (2012) Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA 307(5):483–490

    Article  PubMed  Google Scholar 

  4. Daniels SR (2006) The consequences of childhood overweight and obesity. Future Child 16(1):47–67

    Article  PubMed  Google Scholar 

  5. Guo SS, Chumlea WC (1999) Tracking of body mass index in children in relation to overweight in adulthood. Am J Clin Nutr 70(1):145S–148S

    CAS  Google Scholar 

  6. Guo SS, Huang C, Maynard LM, Demerath E, Towne B, Chumlea WC, Siervogel RM (2000) Body mass index during childhood, adolescence and young adulthood in relation to adult overweight and adiposity: the Fels Longitudinal Study. Int J Obes Relat Metab Disord 24(12):1628–1635

    Article  CAS  PubMed  Google Scholar 

  7. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S (2004) Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 350(23):2362–2374

    Article  CAS  PubMed  Google Scholar 

  8. Hakim F, Kheirandish-Gozal L, Gozal D (2015) Obesity and altered sleep: A pathway to metabolic derangements in children? Semin Pediatr Neurol 22(2):77–85

    Article  PubMed  PubMed Central  Google Scholar 

  9. Alterio A, Alisi A, Liccardo D, Nobili V (2014) Non-alcoholic fatty liver and metabolic syndrome in children: a vicious circle. Horm Res Paediatr 82(5):283–289

    Article  CAS  PubMed  Google Scholar 

  10. Xanthakos S, Miles L, Bucuvalas J, Daniels S, Garcia V, Inge T (2006) Histologic spectrum of nonalcoholic fatty liver disease in morbidly obese adolescents. Clin Gastroenterol Hepatol 4(2):226–232

    Article  PubMed  Google Scholar 

  11. Bibbins-Domingo K, Coxson P, Pletcher MJ, Lightwood J, Goldman L (2007) Adolescent overweight and future adult coronary heart disease. N Engl J Med 357(23):2371–2379

    Article  CAS  PubMed  Google Scholar 

  12. Flannery CA, Rackow B, Cong X, Duran E, Selen DJ, Burgert TS (2013) Polycystic ovary syndrome in adolescence: impaired glucose tolerance occurs across the spectrum of BMI. Pediatr Diabetes 14(1):42–49

    Article  PubMed  Google Scholar 

  13. Zeller MH, Roehrig HR, Modi AC, Daniels SR, Inge TH (2006) Health-related quality of life and depressive symptoms in adolescents with extreme obesity presenting for bariatric surgery. Pediatrics 117(4):1155–1161

    Article  PubMed  Google Scholar 

  14. Janicke DM, Marciel KK, Ingerski LM, Novoa W, Lowry KW, Sallinen BJ, Silverstein JH (2007) Impact of psychosocial factors on quality of life in overweight youth. Obesity (Silver Spring) 15(7):1799–1807

    Article  Google Scholar 

  15. Martin A, Saunders DH, Shenkin SD, Sproule J (2014) Lifestyle intervention for improving school achievement in overweight or obese children and adolescents. Cochrane Database Syst Rev 3:CD009728

    Google Scholar 

  16. Inge TH, Zeller MH, Jenkins TM, Helmrath M, Brandt ML, Michalsky MP, Harmon CM, Courcoulas A, Horlick M, Xanthakos SA, Dolan L, Mitsnefes M, Barnett SJ, Buncher R (2014) Teen-LABS Consortium. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr 168(1):47–53

    Article  PubMed  PubMed Central  Google Scholar 

  17. Treadwell JR, Sun F, Schoelles K (2008) Systematic review and meta-analysis of bariatric surgery for pediatric obesity. Ann Surg 248(5):763–776

    Article  PubMed  Google Scholar 

  18. Paulus GF, de Vaan LE, Verdam FJ, Bouvy ND, Ambergen TA, van Heurn LW (2015) Bariatric surgery in morbidly obese adolescents: a systematic review and meta-analysis. Obes Surg 25(5):860–878

    Article  PubMed  PubMed Central  Google Scholar 

  19. Schilling PL, Davis MM, Albanese CT, Dutta S, Morton J (2008) National trends in adolescent bariatric surgical procedures and implications for surgical centers of excellence. J Am Coll Surg 206(1):1–12

    Article  PubMed  Google Scholar 

  20. Kelleher DC, Merrill CT, Cottrell LT, Nadler EP, Burd RS (2013) Recent national trends in the use of adolescent inpatient bariatric surgery: 2000 through 2009. JAMA Pediatr 167(2):126–132

    Article  PubMed  Google Scholar 

  21. Iqbal CW, Kumar S, Iqbal AD, Ishitani MB (2009) Perspectives on pediatric bariatric surgery: identifying barriers to referral. Surg Obes Relat Dis 5(1):88–93

    Article  PubMed  Google Scholar 

  22. Blondet JJ, Morton JM, Nguyen NT (2015) Hospital accreditation and bariatric surgery: Is it important? Adv Surg 49(1):123–129

    Article  PubMed  Google Scholar 

  23. Serrano OK, Tannebaum JE, Cumella L, Choi J, Vemulapalli P, Scott Melvin W, Camacho DR (2015) Weight loss outcomes and complications from bariatric surgery in the super super obese. Surg Endosc. doi:10.1007/s00464-015-4509-y

    PubMed  Google Scholar 

  24. Reinhold RB (1982) Critical analysis of long term weight loss following gastric bypass. Surg Gynecol Obstet 155(3):385–394

    CAS  PubMed  Google Scholar 

  25. Foster BA, Farragher J, Parker P, Sosa ET (2015) Treatment interventions for early childhood obesity: a systematic review. Acad Pediatr 15(4):353–361

    Article  PubMed  PubMed Central  Google Scholar 

  26. Taveras EM, Marshall R, Kleinman KP, Gillman MW, Hacker K, Horan CM, Smith RL, Price S, Sharifi M, Rifas-Shiman SL, Simon SR (2015) Comparative effectiveness of childhood obesity interventions in pediatric primary care: a cluster-randomized clinical trial. JAMA Pediatr 169(6):535–542

    Article  PubMed  Google Scholar 

  27. Peirson L, Fitzpatrick-Lewis D, Morrison K, Warren R, Usman Ali M, Raina P (2015) Treatment of overweight and obesity in children and youth: a systematic review and meta-analysis. CMAJ Open 3(1):E35–E46

    Article  PubMed  PubMed Central  Google Scholar 

  28. Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD (2011) Interventions for preventing obesity in children. Cochrane Database Syst Rev (12):CD001871. doi:10.1002/14651858.CD001871.pub3

  29. Ells LJ, Mead E, Atkinson G, Corpeleijn E, Roberts K, Viner R, Baur L, Metzendorf MI, Richter B (2015) Surgery for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev 6:CD011740

    Google Scholar 

  30. Strauss RS, Bradley LJ, Brolin RE (2001) Gastric bypass surgery in adolescents with morbid obesity. J Pediatr 138(4):499

    Article  CAS  PubMed  Google Scholar 

  31. Sugerman HJ, Sugerman EL, DeMaria EJ, Kellum JM, Kennedy C, Mowery Y, Wolfe LG (2003) Bariatric surgery for severely obese adolescents. J Gastrointest Surg 7(1):102–107 discussion 107–108

    Article  PubMed  Google Scholar 

  32. Lawson ML, Kirk S, Mitchell T, Chen MK, Loux TJ, Daniels SR, Harmon CM, Clements RH, Garcia VF, Inge TH (2006) One-year outcomes of Roux-en-Y gastric bypass for morbidly obese adolescents: a multicenter study from the Pediatric Bariatric Study Group. J Pediatr Surg 41(1):137–143 discussion 137–143

    Article  PubMed  Google Scholar 

  33. Boza C, Viscido G, Salinas J, Crovari F, Funke R, Perez G (2012) Laparoscopic sleeve gastrectomy in obese adolescents: results in 51 patients. Surg Obes Relat Dis 8(2):133–137 discussion 137–139

    Article  PubMed  Google Scholar 

  34. Raziel A, Sakran N, Szold A, Teshuva O, Krakovsky M, Rabau O, Goitein D (2014) Mid-term follow-up after laparoscopic sleeve gastrectomy in obese adolescents. Isr Med Assoc J 16(1):37–41

    PubMed  Google Scholar 

  35. Inge TH, Miyano G, Bean J, Helmrath M, Courcoulas A, Harmon CM, Chen MK, Wilson K, Daniels SR, Garcia VF, Brandt ML, Dolan LM (2009) Reversal of type 2 diabetes mellitus and improvements in cardiovascular risk factors after surgical weight loss in adolescents. Pediatrics 123(1):214–222

    Article  PubMed  Google Scholar 

  36. Ippisch HM, Inge TH, Daniels SR, Wang B, Khoury PR, Witt SA, Glascock BJ, Garcia VF, Kimball TR (2008) Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol 51(14):1342–1348

    Article  PubMed  Google Scholar 

  37. Miyano G, Jenkins TM, Xanthakos SA, Garcia VF, Inge TH (2013) Perioperative outcome of laparoscopic Roux-en-Y gastric bypass: a children’s hospital experience. J Pediatr Surg 48(10):2092–2098

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kim MK, Kim W, Kwon HS et al (2014) Effects of bariatric surgery on metabolic and nutritional parameters in severely obese Korean patients with type 2 diabetes: a prospective 2-year follow up. J Diabetes Investig 5:221–227

    Article  CAS  PubMed  Google Scholar 

  39. Tzotzas T, Evangelou P, Kiortsis DN (2011) Obesity, weight loss and conditional cardiovascular risk factors. Obes Rev 12:e282–e289

    Article  CAS  PubMed  Google Scholar 

  40. Lubrano C, Mariani S, Badiali M et al (2010) Metabolic or bariatric surgery? Long-term effects of malabsorptive vs restrictive bariatric techniques on body composition and cardiometabolic risk factors. Int J Obes (Lond) 34:1404–1414

    Article  CAS  Google Scholar 

  41. Olbers T, Gronowitz E, Werling M et al (2012) Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS). Int J Obes (Lond) 36(11):1388–1395

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Montefiore Institute for Minimally Invasive Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, MAP 4, Bronx, NY, 104647, USA

    Oscar K. Serrano, Erin Moran-Atkin, Jenny Choi, W. Scott Melvin & Diego R. Camacho

  2. Department of Surgery, Albert Einstein College of Medicine, New York, NY, USA

    Oscar K. Serrano, Yang Zhang, Emily Kintzer, Erin Moran-Atkin, Jenny Choi, W. Scott Melvin & Diego R. Camacho

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  1. Oscar K. Serrano
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Correspondence to Oscar K. Serrano.

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Oscar K. Serrano, Yang Zhang, Emily Kintzer, Erin Moran-Atkin, Jenny Choi, W. Scott Melvin, and Diego R. Camacho have no conflicts of interest or financial ties to disclose.

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Serrano, O.K., Zhang, Y., Kintzer, E. et al. Outcomes of bariatric surgery in the young: a single-institution experience caring for patients under 21 years old. Surg Endosc 30, 5015–5022 (2016). https://doi.org/10.1007/s00464-016-4849-2

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  • DOI: https://doi.org/10.1007/s00464-016-4849-2

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