Where Should Adolescents Undergo Bariatric Surgery?

Nicole A Kissane, MD, Rose Lovett, PA, Mark J Gorman, PhD, Renee Kalmbach, David Lawlor, MD, Paul Boepple, MD, Alison G Hoppin, MD, Janey S Pratt, MD. Department of Surgery, Massachusetts General Hospital

INTRODUCTION: Bariatric centers of excellence are providing care and weight loss surgery (WLS) for patients with severe obesity across the United States. Incorporation of adolescent patients into existing adult centers facilitates access, continuity, and expertise of care to these younger populations.

METHODS AND PROCEDURES: In 2009 an adolescent WLS program was integrated into our established adult WLS program. This necessitated involvement of a dedicated team of pediatric, surgical, psychiatric, dietary, and nursing personnel specifically trained in adolescent populations and family-based therapy. A long term follow-up program for transition into adulthood was coordinated alongside our existing postoperative support program. Care was taken to emphasize family-based programs which promote adolescent autonomy and long term postoperative compliance.

RESULTS: In a 15 month period, 9 adolescent patients (6 females, 3 males) underwent laparoscopic roux-en-y retrocolic gastric bypass (LGBP) at our institution. Median age at the time of operation was 17 years (range 14 to 21 years), and median BMI was 51.8 (range BMI 45.7 to 68). Median follow-up was 6 months (range 3 to 15 months). There were no immediate postoperative complications. Length of stay was three days for all patients. Two patients were readmitted within 8 months for symptomatic cholelithiasis. The mean decrease in BMI at 3 months was 7.8 kg/m² (n=9). The mean decrease in BMI at 6 months was 12.4 kg/m² (n=4). The mean decrease in BMI at one year was 12.6 kg/m² (n=2). The effect on co-morbidities has demonstrated improved hypertension, diabetes, dyslipidemia, sleep apnea, gastroesophageal reflux, and musculoskeletal issues. Vitamin deficiencies were the only noted factors requiring increased medical attention in the postoperative period. Postoperative mental health evaluations (n=9) demonstrated reasonable patient expectations, continued postoperative motivation, and no postsurgical biopsychosocial issues.

CONCLUSIONS: Adolescent WLS can be successfully incorporated into an existing adult program. Essential modifications include measuring postoperative success by BMI (rather than excess body weight) to account for adolescent growth, family-based support systems, and education for long term disease and nutrition follow-up.