Duodenal Switch, SADI, and SIPS in Adolescent

Abstract

Adolescent obesity is rising at alarming rates, and it has been demonstrated that lifestyle modifications alone are not successful methods for sustained weight loss. A mountain of evidence has established the role of metabolic and bariatric surgery in adolescents over the years, and most have proven to be effective and safe. Currently, the sleeve gastrectomy is the most common procedure performed, along with the Roux-en-Y gastric bypass. Both of these procedures provide similar weight loss outcomes with near-complete reversal of obesity-related comorbidities. The biliopancreatic diversion with duodenal switch and its derivatives are very efficient malabsorptive procedures, especially in the super obese population. Although some studies have used this procedure in adolescents with promising outcomes, there is still very limited data to support its clear benefit and safety profile in this age population. The potential risks for severe protein malnutrition, vitamin deficiencies, and bone health seem to influence most healthcare professionals to not consider this as a safe option despite the lack of any convincing evidence. The ASMBS and the American Academy of Pediatrics have made clear recommendations to avoid the use of this procedure in adolescents. A multidisciplinary approach is recommended when considering an adolescent with severe obesity for metabolic and bariatric surgery. We believe that early intervention is crucial and if required the biliopancreatic diversion with duodenal switch or its derivatives can be a part of the treatment armamentarium as a likely staged approach once adulthood has been reached.