Medscape Pediatrics > Viewpoints
Short-term Outcomes of Bariatric Surgery in Teens
William T. Basco, Jr., MD, MSDisclosures
March 17, 2014
2 comments
Print
EDITORS' RECOMMENDATIONS
Type 2 Diabetes in Adolescents: A Complex Issue
Bariatric Surgery Safe in Severely Obese Teenagers
Bariatric Surgery 'Underutilized' in Morbidly Obese Kids
Perioperative Outcomes of Adolescents Undergoing Bariatric Surgery: The Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study
Inge TH, Zeller MH, Jenkins TM; Teen-LABS Consortium
JAMA Pediatrics. 2014;168:47-53
Study Summary
Compared with nonsurgical interventions, surgical approaches to weight reduction appear to have greater success at substantial reduction in body mass Index (BMI). Although bariatric surgery is not commonly performed in adolescents, the procedure has been gaining acceptance in that population for selected patients.
This study was a prospective, longitudinal effort to follow the outcomes of adolescent bariatric surgery completed at 5 medical centers in the United States. The patients were all ≤ 19 years of age and treated between 2007 and 2011.
The care plans were determined by each institution, but all surgeons were trained in uniform data collection for the study. Study personnel collected preprocedure data at an in-person interview of the patients. They also completed chart reviews, physical examinations, and repeat patient interviews as part of the follow-up procedures.
Perioperative outcomes of interest were "major complications," defined as any complication that was life-threatening, had the potential to cause permanent harm, any organ loss, any reoperation, receipt of a blood transfusion, or any major deviation from the anesthesia or operative plan. "Minor complications" were unplanned events, such as organ laceration, procedures that had to be revised during the primary operation, any injury to adjacent structures, or failure to be discharged on oral feedings only (meaning, discharged on either supplemental intravenous or tube feedings).
During the first 30 days after the procedure, the investigators also collected data on the frequencies of major and minor complications. Major complications in the 30 days after surgery were any that were life-threatening, had potential for permanent harm, or any reoperation in the abdominal cavity. Minor complications included endoscopic interventions, use of nonoral or parenteral nutrition at the 30-day postoperation point, or readmission to the hospital for any reason.
Study Findings
There were 242 participants in this study (76% girls), with a mean age of 17 years at the time of surgery; 72% were white, 22% were black, and 7% were Hispanic. The median BMI was 50.5 kg/m2, and 21% of the participants had a BMI ≥ 60 kg/m2. Comorbid conditions were common -- 74% of the patients had dyslipidemia; 57% had sleep apnea; and more than 40% had joint pain, hypertension, or back pain. In fact, 51% of the patients presented with 4 or more comorbid conditions.
Two thirds of the patients underwent a Roux-en-Y gastric bypass, 5.8% had an adjustable gastric band, and 27.7% had a vertical sleeve gastrectomy. Over the study period, there was a gradual decline in the use of adjustable gastric band procedures and an increase in the use of the vertical sleeve gastrectomy.
In the perioperative (short-term) outcome period, 5% of the patients experienced a major (obstruction, bleeding, or gastrointestinal leak) complication, and 7.9% a minor complication. For the 30-day outcomes, 7.9% of patients experienced a major complication and 14.9% experienced a minor complication. No patient died.
The point estimates for major complication by procedure were 9.3% for the Roux-en-Y procedure, 4.5% for the vertical sleeve gastrectomy, and 7.1% for the adjustable gastric band. However, the 95% confidence intervals for these estimates had a great deal of overlap, suggesting that these differences were not significant.
The major complications were quite varied and included pulmonary embolus, gastrointestinal leaks (with and without requiring surgical repair), and suicidal ideation. A review of readmissions suggested that 85% were related to the surgical procedure.
The investigators concluded that the safety profile of weight-loss surgery in adolescence was favorable, with 92% of the teens undergoing the procedure without a major complication. This frequency of major complication compares favorably with studies in adults who underwent gastric bypass surgery.
Viewpoint
Given that every pediatric provider may eventually have to counsel a family on the pros and cons of weight-loss surgery, this article is invaluable as a reference. The extent of comorbid conditions among these obese adolescents was considerable, and the conditions were those that certainly carry significant risk by themselves. Part of me wonders what the 30-day morbidity is for obese adolescents with 4 or 5 medical comorbid conditions, even without bypass surgery?