Laparoscopic Sleeve Gastrectomy in Morbidly Obese Children Below 14 Years of Age

Aayed R Alqahtani, MD, FRCSC, FACS, Mohamed O Elahmedi, MD. Obesity Chair, Department of Surgery, College of Medicine, King Saud University.

Background
In spite of the increased prevalence of extreme obesity and its associated comorbid conditions at earlier ages, treating younger children with bariatric surgery is not yet accepted due to concerns regarding safety and efficacy as well as effect on growth. This has denied children a treatment shown to cause effective weight loss, cure of comorbidities, and improvement in the quality of life. No previous study has evaluated the outcomes of bariatric surgery performed exclusively on children below 14 years of age. Herewith, we present the largest experience to date of performing Laparoscopic Sleeve Gastrectomy on this age group.

Methods
We performed a retrospective review on prospectively collected data of all morbidly obese children below the age of 14 who underwent LSG between April 2008 and August 2013. We analyzed patient demographics, anthropometric measurements and comorbidities at baseline and at each follow-up point. Effect on growth was assessed using the growth velocity charts constructed by Tanner and Davies.

Results
The review yielded 94 children among whom 10 had Prader-Willi Syndrome and 3 had Bardet-Biedl Down’s, and Kleinfelter Syndromes each. Median age was 10.5 ± 2.7 years. Median preoperative BMI was 43.6 kg/m2. Median %EBMIL at 1-year was 63.5% (n=45) and at 2-years it was 59.6% (n=21) (Figure 1).
Comorbidity data indicate that 8 (88.9%) hypertensive children experienced complete resolution. All 10 children with prediabetes and diabetes were cured, while normalization was observed in 41.7% of the chidren for total cholesterol, 71.0% for triglycerides, 33.3% for LDL, and 67.6% for HDL levels. Of the 32 chidren who had symptoms of obstructive sleep apnea (OSA), 30 (93.75%) showed complete symptom resolution after surgery. Overall, LSG achieved cure or improvement of 89.7% of comorbidities.
All children experienced normal growth velocity, with no mortality or significant morbidity.

Conclusion
This study challenges the existing concern regarding the safety and efficacy of BS in younger children. It demonstrates that LSG is a safe and effective bariatric procedure in this age group, resulting in significant weight loss, resolution of comorbidities, with no mortality or significant morbidity.

Figure 1. Median %EBMIL for children who underwent LSG below the age of 14

Table 1. Comorbidity resolution in children below the age of 14 who underwent LSG
     
Comorbidity Cured Improved No Change
LDL 34.6% (9) 30.8% (8) 34.6% (9)
HDL

66.7% (26)

33.3% (13) 0.0% (0)
TC 48.3% (14) 27.6% (8) 24.1% (7)
Triglycerides 71.8% (28) 20.5% (8) 7.7% (3)
Fasting bloog glucose 100.0% (10) 0.0% (0) 0.0% (0)
Hypertension 88.9% (8) 11.1% (1) 0.0% (0)
Obstructive Sleep Apnea 93.75% (30) 6.25% (2) 0.0% (0)
Cure + Improvement 89.7% (165)   10.3% (19)

 

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