Best Practice Updates for Pediatric/Adolescent Weight Loss Surgery

Abstract

The objective of this study is to update evidence-based best practice guidelines for pediatric/adolescent weight loss surgery (WLS). We performed a systematic search of English-language literature on WLS and pediatric, adolescent, gastric bypass, laparoscopic gastric banding, and extreme obesity published between April 2004 and May 2007 in PubMed, MEDLINE, and the Cochrane Library. Keywords were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. In light of evidence on the natural history of obesity and on outcomes of WLS in adolescents, guidelines for surgical treatment of obesity in this age group need to be updated. We recommend modification of selection criteria to include adolescents with BMI ≥ 35 and specific obesity-related comorbidities for which there is clear evidence of important short-term morbidity (i.e., type 2 diabetes, severe steatohepatitis, pseudotumor cerebri, and moderate-to-severe obstructive sleep apnea). In addition, WLS should be considered for adolescents with extreme obesity (BMI ≥ 40) and other comorbidities associated with long-term risks. We identified >1,085 papers; 186 of the most relevant were reviewed in detail. Regular updates of evidence-based recommendations for best practices in pediatric/adolescent WLS are required to address advances in technology and the growing evidence base in pediatric WLS. Key considerations in patient safety include carefully designed criteria for patient selection, multidisciplinary evaluation, choice of appropriate procedure, thorough screening and management of comorbidities, optimization of long-term compliance, and age-appropriate fully informed consent.

Trends and Outcomes of Adolescent Bariatric Surgery in California, 2005–2007

“…Current criteria for adolescent bariatric surgery include a BMI of Ͼ35 with major comorbidities or a BMI of Ͼ40 with minor comorbidities. 11 In addition, patients are generally required to have reached physical/ skeletal maturity and undergo a trial of behavior therapy and psychosocial evaluation. 38 Despite the limitations inherent in making population-based estimates, discrepancies in the use of bariatric surgery according to race are quite pronounced and mirror those seen in the adult population.…”

“…Although use of the gastric band is increasing, gastric bypass remains the gold standard of weight-loss surgery for both adults and adolescents because of better weight loss and comorbidity resolution and proven durability. 11,40 For these reasons, insurance companies may be less likely to cover gastric banding than gastric bypass, especially when used off-label for patients younger than 18 years. 41,42 Our data revealed no deaths and a relatively low in-hospital complication rate (Ͻ6%).…”

“…In adolescents, laparoscopic Rouxen-Y gastric bypass (LRYGB) can result in significant weight loss, reduction in comorbidities, and improvement in quality of life. [8][9][10][11][12] Laparoscopic adjustable gastric banding (LAGB) has not been approved by the US Food and Drug Administration for patients younger than 18 years. Although early results with LAGB have indicated that it is safe and effective, [13][14][15][16] long-term outcomes have not yet been reported for adolescents.…”

Effect of ethnicity on weight loss among adolescents 1 year after bariatric surgery

“…However, the optimal age in adolescence for bariatric surgery is as yet undetermined [24] . Our findings, and those of others [26,27] indicate that bariatric surgery before adulthood can substantially reduce weight [10,25] and resolve comorbidities [25] . Moreover, earlier treatment of obesity may prevent later costs.…”

“…Despite standardized indications for bariatric surgery in adolescents [25] , obese children are not simply younger versions of obese adults; they are still developing and growing, both physically and psychologically. Extreme obesity should be treated sooner rather than later [8] , particularly in adolescents, who may have not yet developed full-blown, related comorbidities, such as diabetes or heart disease.…”