Bariatric Surgery in Adolescents, Our Experience

Mujjahid Abbas, MD, L Cumella, BS, J Choi, MD, P Vemulapalli, MD, E. Reynolds, MD, Diego R Camacho, MD. Montefiore Medical Center, Childrens Hospital at MMC.

Adolescent obesity has become a health care problem of great magnitude.  There is no reliable long term medical remedy available. Diet and exercise fail in great majority of the adolescents suffering from morbid obesity. Many of the adolescents suffering from morbid obesity are super obese or even super-super obese. The surgical intervention has been proven to be safe and effective although acceptance is still at a lower level.  Laparoscopic Gastric Band( LGBa), Laparoscopic Gastric Bypass) LGBP) and recently increasingly Laparoscopic Sleeve gastrectomy( LSG) are being offered as surgical options. We, at Montefiore Medical Center, run a high volume Bariatric surgery program and have been offering these interventions to the adolescent population for last few years. At our institution Adolescent population is defined as age 21 years and under. More than 60 patients have undergone bariatric surgical procedures at our institution in last 4 years.

To review the outcomes of bariatric surgical interventions performed at our institution in morbidly obese adolescent patients. To verify the effectiveness of different interventions and compare the data with reported literature.

Adolescent 21 and under were selected through the registry of bariatric cases performed in last 4 years. A retrospective analysis of medical records through chart review was performed. Relative clinical information was obtained through chart review of surgical or medical provider’s notes and phone call interview were performed where necessary in patients who had not followed up regularly in clinic.

61 patients underwent the interventions. 5 patients who underwent lap Band placement were excluded; follow up was not available for two of these patients. Follow up was not available for two additional patients who underwent Lap GBP. Remaining 54 patients were included in the review. 14(26%) were male and 40(74%) were females. 37(68.52%) patients underwent Laparoscopic Gastric bypass and 17(31.48%) patients underwent Laparoscopic Sleeve Gastrectomy. Average pre-op weight was 309.14+/-59.66 Lbs., average pre-op BMI was 51.50+/-9.55. Average Excess Body Weight was 160.78+/-54.34. Follow Up ranged 1-48 months with average 13.61 months. Average weight loss was 76.20+/-39.81Lbs Average Excess Body Weight Loss was 50.70% +/-27.65. Average EBWL was 32% at 3 months, 57.09% at 6 months, 59% at one year, 67.97%at 2 years, 78% at 3 years. There were no leaks, no re-operations, no deaths, no DVT and No PEs reported. One patient developed stricture at G-J anastomosis and required endoscopic dilatation. One patient developed neuropathy secondary to vitamin deficiency. Pre-Existing Co-morbidities included HL( 4%),DM(5.56%), PCOS( 10% Female patients),HTN( 19%), OSA(22.22%),Asthma(31.48%). Significant resolution or symptomatic improvement of the comorbid conditions was reported.

Bariatric surgery is most viable option for the morbidly obese adolescents and benefits are not limited to weight loss only but improvement of multiple aspects of patients overall health. Our results are comparable to reported results in other published series in US and worldwide. Long term effects of these surgical interventions although remain to be analyzed in coming decades and will need further investigations.

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