Laparoscopic sleeve gastrectomy in adolescents with or without syndromic obesity: two years follow-up
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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/m2) 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 co-morbidities after 2 years of follow-up.
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, co-morbidity 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.
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.
KeywordsBariatric surgery in teenagers Childhood obesity Sleeve gastrectomy Adolescents Syndromic obesity Surgical treatment
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Michalsky MP, Inge TH, Simmons M, Jenkins TM, Buncher R, Helmrath M, Brandt ML, Harmon CM, Courcoulas A, Chen M, Horlick M, Daniels SR, Urbina EM (2015) Cardiovascular risk factors in severely obese adolescents: the teen longitudinal assessment of bariatric surgery (Teen-LABS) Study. JAMA Pediatr 169(5):438–444. doi: 10.1001/jamapediatrics.2014.3690 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Inge TH, Zeller MH, Jenkins TM, Helmrath M, Brandt ML, Michalsky MP, Teen-LABS Consortium et al (2014) Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr 168(1):47–53. doi: (10.1001/jamapediatrics.2013.4296) CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Michalsky MP, Inge TH, Teich S, Eneli I, Miller R, Brandt ML, Teen-LABS Consortium et al (2014) Adolescent bariatric surgery program characteristics: the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study experience. Semin Pediatr Surg 23(1):5–10. doi: 10.1053/j.sempedsurg.2013.10.020 (epub 2013 Oct 31) CrossRefPubMedGoogle Scholar
- 10.Zeller MH, Inge TH, Modi AC, Jenkins TM, Michalsky MP, Helmrath M et al (2015) Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Consortium. Severe obesity and comorbid condition impact on the weight-related quality of life of the adolescent patient. J Pediatr 166(3):651–659. doi: 10.1016/j.jpeds.2014.11.022 (epub 2014 Dec 30) CrossRefPubMedGoogle Scholar
- 12.http://www.sicob.org/area_04_medici/60_protocolli.aspx. Accessed 23 Oct 2016
- 13.Rosenthal RJ, Diaz AA, Arvidsson D, Baker RS, Basso N, Bellanger D et al (2012) International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 8(1):8–19. doi: 10.1016/j.soard.2011.10.019 (epub 2011 Nov 10) CrossRefPubMedGoogle Scholar
- 15.Expert Panel on Integrated Guidelines for Cardiovascular Health, and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute (2011) Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 128(Suppl 5):S213–S256. doi: 10.1542/peds.2009-2107C (epub 2011 Nov 14) CrossRefGoogle Scholar
- 19.Zawadzki JK, Dunaif A (1992) Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine FP, Merriam GR (eds) Polycystic ovary syndrome. Blackwell, Boston, pp 377–384Google Scholar
- 21.Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. doi: 10.1097/SLA.0b013e3181b13ca2 CrossRefPubMedGoogle Scholar
- 23.Van Mil SR, Biter LU, Grotenhuis BA, Zengerink JF, Mannaerts GH (2016) Laparoscopic Sleeve Gastrectomy versus Gastric Bypass in Late Adolescents: What Is the Optimal Surgical Strategy for Morbid Obesity? Eur J Pediatr Surg (epub ahead of print)Google Scholar
- 25.Blüher S, Raschpichler M, Hirsch W, Till H (2013) A case report and review of the literature of laparoscopic sleeve gastrectomy in morbidly obese adolescents: beyond metabolic surgery and visceral fat reduction. Metabolism 62(6):761–767. doi: 10.1016/j.metabol.2012.11.001 epub 2012 Dec 6 CrossRefPubMedGoogle Scholar
- 30.Tsamis D, Plastiras A, Natoudi M, Oikonomou E, Zografos G, Leandros E, Albanopoulos K (2015) Impact of Laparoscopic Sleeve Gastrectomy on Weight Loss and Associated Co-morbidities in Adolescents and Young Adults. J Laparoendosc Adv Surg Tech A 25(12):971–975. doi: 10.1089/lap.2015.0426 (epub 2015 Nov 5) CrossRefPubMedGoogle Scholar
- 34.Alqahtani AR, Elahmedi MO, Al Qahtani AR, Lee J, Butler MG (2015) Laparoscopic sleeve gastrectomy in children and adolescents with Prader–Willi syndrome: a matched-control study. Surg Obes Relat Dis S1550–7289(15):00301–00309. doi: 10.1016/j.soard.2015.07.014 (epub ahead of print) CrossRefGoogle Scholar
- 36.Gumus Balikcioglu P, Balikcioglu M, Muehlbauer MJ, Purnell JQ, Broadhurst D, Freemark M (2015) Macronutrient regulation of ghrelin and peptide YY in pediatric obesity and Prader–Willi syndrome. J Clin Endocrinol Metab 100(10):3822–3831. doi: 10.1210/jc.2015-2503 (epub 2015 Aug 10) CrossRefPubMedPubMedCentralGoogle Scholar