Best Practice Guidelines in Pediatric/Adolescent Weight Loss Surgery

Abstract

MICHAEL TARNOFF. Best practice guidelines in pediatric/adolescent weight loss surgery. Obes Res. 2005; 13:274 -282. Objective: To establish evidence-based guidelines for best practices in pediatric/adolescent weight loss surgery (WLS). Research Methods and Procedures:We carried out a systematic search of English-language literature in MEDLINE on WLS performed on children and adolescents. Key words were used to narrow the field for a selective review of abstracts. Data were extracted, and evidence categories were assigned according to a grading system based on established evidence-based models. Eight pertinent case series, published between 1980 and 2004, were identified and reviewed. These data were supplemented with expert opinions and literature on WLS in adults. Results: Recommendations focused on patient safety, reduction of medical errors, systems improvements, credentialing, and future research. We developed evidence-based criteria for eligibility, assessment, treatment, and follow-up; recommended surgical procedures based on the best available evidence; and established minimum guideline requirements for data collection. Discussion: Lack of adequate data and gaps in knowledge were cited as important reasons for caution. Physiological status, comprehensive screening of patients and their families, and required education and counseling were identified as key factors in assessing eligibility for surgery. Data collection and peer review were also identified as important issues in the delivery of best practice care.

Recommendations for Treatment of Child and Adolescent Overweight and Obesity

“…This is particularly important for adolescents, because the long-term effects of bariatric surgery in younger, reproductively active populations have not been well characterized. 266,270,271 Given the limited quantity and scope of data on the risks and benefits of adolescent bariatric surgery, a conservative approach is needed.…”

Bariatric Surgery in Adolescents

“…6,7 On the basis of these factors, a number of pediatric groups have suggested that bariatric surgery is an appropriate treatment for carefully selected morbidly obese adolescents with severe comorbidities. [8][9][10][11] To date, a range of different types of bariatric procedures has been performed in this age group, including gastric bypass, vertical banded gastroplasty, and adjustable gastric banding.…”

Is There an Indication for BPD-DS/BPD? What the Potential Advantages/Disadvantages to RYNGB?

“…In conclusion RYGB is to be recommended (Apovian et al 2005) as the procedure with the best long-term data and LAGB as the procedure with the least apparent risk for adolescent patients. Because there are currently no criteria to determine which of the two procedures (RYGB or LAGB) is best for any given patient, the decision should rest with the gender of the patient, the patient, the needed BMI-Loss, his or her parents or guardians, and the surgeon and other members of the team (pediatrician, psychologist, etc.)…”

“…comorbidities, and improved self-image and socialization (Apovian et al 2005;Inge et al 2004a;Dolan et al 2003;Stanford et al 2003;Capella and Capella 2003).…”