Bariatrische Chirurgie bei extremer Adipositas im Kindes- und Jugendalter

Abstract

The management of childhood obesity is a clinical dilemma. Validated and evidence-based intervention programs are still missing for this age group, and pediatricians increasingly see children with morbid obesity and with obesity-related comorbidities. For those extremely obese patients who failed to respond to the classical therapeutic approaches, bariatric surgery is a therapeutic option. Although available data for bariatric surgery in childhood and adolescence is limited to date, significant postoperative reduction in BMI and an evident improvement of preoperatively existing metabolic and cardiovascular comorbidities and psychosocial well-being have been reported. The indication for bariatric surgery in adolescents follows strict criteria and should be proposed within an interdisciplinary team in specialized centers, including a clinical ethics committee. This review discusses the present guidelines for bariatric surgery in childhood and adolescence as well as available follow-up data for both adults and pediatric patients.

Bariatric surgery for obese children and adolescents: a review of the moral challenges

“…What is the efficacy, effectiveness, and efficiency of bariatric surgery? Utilitarian assessments of bariatric surgery for young people are difficult as high quality knowledge on benefits is scarce[39]. Knowledge from uncontrolled series’ from selected centers indicates that bariatric surgery may be beneficial [40], but, evidence on important outcome measures is lacking [19,25].…”

Chancen und Risiken der bariatrischen Chirurgie im Kindes- und Jugendalter

“…In den letzten Jahren wurde die Studienlage nunmehr um einige größere prospektive Studien mit aussagekräftigen Follow-up-Zeiten bis zu 5 Jahren ergänzt. Diese belegen allesamt eine gute Wirksamkeit bariatrischer Eingriffe auf Gewichts-und BMI-Reduktion sowie eine Überlegenheit im Vergleich zu konservativen Interventionen [1][2][3][4][5][6][7][8]. In der TeenLabs-Studie konnte an 228 Jugendlichen im Alter von 13-19 Jahren eine durchschnittliche BMI-Reduktion um 13 kg / m 2 bei der Sleeve-Gastrektomie sowie um 15 kg / m 2 bei Roux-en-Y-Bypass (RYGB) nachgewiesen werden [1].…”