Challenges of bariatric surgery in adolescents with obesity

Abstract

bypass INTRODUCTION Obesity is a complex, multifactorial condition and one of the most frequent pathology encountered in practice worldwide, which after the SARS-COV-2 pandemic period took a rapid increase of prevalence in children and adolescents, which almost tripled. By increasing the prevalence of overweight and obesity, both in the paediatric population and in adults, there is a high risk of comorbidities with multiple social and economic consequences [1].The prevalence of obesity over time has almost tripled since 1975 according to the World Health Organization. In 2016, there were more than 650 million obese adults, with age 18 years and older (13%), and for children and adolescents ReviewOpen Access Abstract. Challenges of bariatric surgery in adolescents with obesityObjective: Obesity is a multifactorial condition and one of the most frequent pathology encountered in practice worldwide, who took a big increase of prevalence in children and adolescents after the SARS-COV-2 pandemic period. The aim of this review is to evaluate the surgical treatment options, outcomes, and clinical indications in adolescents with severe obesity, focusing on types of procedures, nutritional management and resolution of metabolic comorbidities. Materials and method: In this review we analysed the most relevant published studies (original papers and reviews) in the scientific literature. The literature search of articles was made in electronic international indexed databases PubMed, Medline and Web of Science. The papers published up to November 2022 were searched with the following keywords: obesity, adolescents, bariatric surgery, obesity complications, metabolic risk, sleeve gastrectomy, clinical indications for bariatric surgery. Results: The bariatric surgery is a safe and effective treatment for the population younger than 18 years, with durable weight loss and improvement in comorbid conditions. Laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass are the most common bariatric surgery procedures performed in both adolescent and adult patients, with an average percent body mass index loss between 25-29% after surgery. In bariatric surgery is recommended a multidisciplinary approach to evaluate the eligible candidates, especially for an adolescent. Following the bariatric surgery, the patients must optimize their lifestyle habits and make healthy dietary choices. Multiple studies have demonstrated important improvements, prevention and even remission of complications of obesity. Psychosocial issues and the quality of life are important components in evaluating the patients diagnosed with obesity. Conclusions: The prevention and treatment of obesity and comorbidities in adolescence are key strategic goals, in order to reduce morbidity, mortality in adulthood. The early results in bariatric surgery, made in both sleeve gastrectomy or Roux-en-Y gastric bypass technique, have all indicated that adolescent surgical intervention is a successful therapeutic option, if lifestyle modifications fail.