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Weight-loss surgery appears successful for overweight adolescents
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Results of a systemic review of 37 studies ranging more than 30 years show that bariatric surgery is associated with significant weight loss and improved comorbidities and quality of life in older children and adolescents; however, postoperative complications, compliance and long-term follow-up are problematic in these younger patients.
Andrea Aikenhead, MSc, of the International Association for the Study of Obesity in London, and researchers conducted a database search for studies that examined participants aged younger than 19 years who reported at least one postoperative weight-loss measure and had at least 1 year of postoperative follow-up. Their search yielded 37 relevant papers on bariatric surgery effectiveness in 831 children and adolescents; the studies spanned 36 years.
Surgery at a younger age
Eight papers studied Roux-en-Y gastric bypass; mean BMI reductions ranged from 9 kg/m2 to 25 kg/m2. Other bariatric procedures, including sleeve gastrectomy, vertical banded gastroplasty and biliopancreatic diversion, were examined in 14 studies. In these, mean BMI reductions ranged from 9 kg/m2 to 24 kg/m2.
“The majority of studies reported resolution or improvement of comorbid conditions,” the researchers wrote in the study.
However, weight regain was reported in three studies. In addition, three surgery-related deaths were reported. A range of postoperative complications across surgery types occurred, including ulcers, intestinal leakage, wound infection, anastomotic stricture, nutritional deficiencies, bowel obstruction, pulmonary embolism, disrupted staple lines, band slippage, psychological intolerance and repeated vomiting.
Only one study conducted in Australia provided evidence that bariatric surgery — specifically, laparoscopic adjustable gastric banding — was cost-effective in this age group.
“Availability of long-term data on safety, effectiveness and cost-effectiveness remains largely unknown,” the researchers wrote. They concluded that until quality evidence is available, “a cautious approach to child and adolescent bariatric surgery is warranted, and reversible techniques are advisable compared to approaches that permanently alter anatomy.”
A guideline review
In another study published in Clinical Obesity, Aikenhead and colleagues reviewed current recommendations from 15 sets of guidelines on bariatric surgery in adolescents. All of the guidelines were released in the last 6 years.
“Nearly all suggested that bariatric surgery is indicated for obese pediatric patients after previous failed attempts at weight loss,” the researchers wrote.
Although the guidelines all contained information on patient selection criteria, surgical team and institution requirements, and suggested preoperative and postoperative protocols, there was little consensus on the criteria specified within the categories, according to the researchers. Appropriate age and degree of obesity had different recommendations among the guidelines reviewed. In addition, few guidelines addressed preoperative and postoperative care requirements.
“There is lack of uniformity in the guidance in this area, indicative of the complex nature of obesity management for younger patients,” the researchers wrote. “While guidance is necessary to inform and update clinicians, obese pediatric patients require individualized assessment and care.”
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