Laparoscopic Sleeve Gastrectomy in Adult and Pediatric Obese Patients: A Comparative Study

Aayed R Alqahtani, FRCSC FACS, Mohamed Elahmedi, MD, Hussam Alamri, MD. King Saud University, College of Medicine, Department of Surgery

 

Introduction
Bariatric surgery is currently the most effective approach for long-term weight loss in morbidly obese adults. Laparoscopic sleeve gastrectomy (LSG) is a recent bariatric procedure that has gained widespread popularity due to its association with significant weight loss, resolution of comorbidities, and a low complication rate. However, pediatric bariatric surgery is controversial, and the type(s) of bariatric surgery that are suitable for children and adolescents is under debate. There are no existing studies comparing bariatric surgery outcomes in adult and pediatric patients.
We performed a retrospective review of the safety, efficacy, and complications of LSG in adult and pediatric morbidly obese patients.

Methods and Procedures
A retrospective review of all patients who underwent LSG between March 2008 and February 2011 was performed. The 208 patients included 108 pediatric patients aged 21 years or younger, and 100 adult patients older than 21 years. Patient demographics, weight, height, operative time, hospital stay, weight loss, and post-operative complications were evaluated.

Results
Pediatric patients had a mean age of 13.9 ± 4.3 years and a median baseline BMI of 47.4 kg/m2 (range 31.8-96.9), while adults had a mean age of 34.0 ± 9.3 years, and a median baseline BMI of 46.1 kg/m2 (range 35.3-82.2). At 3, 6, 12, and 24 months postoperatively, median percentages of excess weight loss and excess BMI loss are shown in Table 1.

During the 24-month follow-up period, pediatric patients attended 213 of 301 (70.7%) follow-up visits, whereas adults attended 144 of 258 (55.8%) follow-up visits.
Postoperative complications occurred in 6 (5.6%) pediatric patients. One (0.9%) was readmitted for a suspected leak and managed conservatively, 2 had wound infections (1.9%), and 3 had heartburn (2.8%). There were no confirmed leaks or mortalities.
Postoperative complications occurred in 7 (7.0%) adult patients. One suffered a staple line leak that required reoperation, 1 was readmitted with pulmonary embolism, 2 had prolonged postoperative stay due to pneumonia, 2 had prolonged nausea and vomiting, and 1 had wound infection. There were no mortalities.

Table 1. Weight Loss and Follow-up Compliance in Pediatric and Adult Patients Following Laparoscopic Sleeve Gastrectomy.
 Age Group     Baseline    3
Months
6
Months
12
Months
24
Months
Median BMIPediatric (n)
Adult (n)
47.4 (108)
46.1(100)
39.6(88)
40.8(59)
33.9(76)
35.8(50)
31.2(42)
30.1(42)
30.8(8)
28.9(9)
Median Percentage 
Excess BMI Loss
Pediatric 1
Adult 2
 31.4%
35.5%
52.8%
55.4%
68.9%
75.7%
81.6%
81.9%
Median Percentage
Excess Weight Loss
Pediatric 1
Adult 2
 28.9%
35.5%
48.1%
55.4%
61.3%
75.7%
62.3%
81.9%
CompliancePediatric
Adult
 81.5%
58.9%
75.2%
51.6%
52.6%
79.5%
57.1%
72.4%

1 From BMI for age-and-gender corresponding to 85th percentile
2 From BMI or the weight corresponding to BMI of 25 kg/m2
 

Conclusions

Laparoscopic sleeve gastrectomy in the pediatric age group is as safe and effective as it is in adults. Pediatric patients had fewer “serious” complications and were more compliant with follow-up than adults. Nevertheless, long-term results are required to further clarify the safety and efficacy of LSG in pediatric patients.
 


Session Number: SS23 – Plenary II
Program Number: S131

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