Long-term follow-up and the role of surgery in adolescents with morbid obesity

Barnett, Sean J.; Stanley, Christopher; Hanlon, Melanie; Acton, Robert D.; Saltzman, Daniel A.; Ikramuddin, Sayeed; Buchwald, Hēnry

doi:10.1016/j.soard.2005.03.206

Cited by 45 publications

(32 citation statements)

References 29 publications

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“…The dumping syndrome is often quoted, as mentioned previously, to be a major drawback of RYGB surgery (30,32). In our unit, we have shown that most patients, including adolescents, do not experience any symptoms of dumping after RYGB (31), although the prevalence has been reported elsewhere at over 75% (105).…”

Section: Exceptional Circumstancessupporting

confidence: 57%

“…The dumping syndrome is divided into early dumping, with gastrointestinal symptoms, and late dumping, typically occurring 1-3 h after a meal without gastrointestinal symptoms (30). Dumping has been reported in adolescents after 32). Furthermore, all techniques involve a risk of vitamin and micronutrient deficiency, which some worry could lead to a degree of growth retardation.…”

Section: Introductionmentioning

confidence: 99%

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Should bariatric surgery be performed in adolescents?

Beamish

Reinehr

2017

European Journal of Endocrinology

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Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications.

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Section: Exceptional Circumstancessupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Should bariatric surgery be performed in adolescents?

Beamish

Reinehr

2017

European Journal of Endocrinology

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“…220 Five articles over the past decade reported intermediate-to longterm outcomes of various operations including RYGB, [221][222][223][224][225] whereas fewer reported only RYGB outcomes. .…”

Section: Roux En Y Gastric Bypassmentioning

confidence: 99%

“…Several reports of death unrelated to surgery that occurred 9 months, 79 4 years, 221 and at 2 and 6 years 225 after RYGB have been reported. The typical complications of major gastrointestinal surgery have been seen after RYGB in adolescents, including anastomotic stricture, leak, wound infection, bowel obstruction, bleeding, ulceration, pneumonia, vitamin deficiency, 232 and venous thromboembolism.…”

Section: Roux En Y Gastric Bypassmentioning

confidence: 99%

Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches

Kelly¹,

Barlow

Rao³

et al. 2013

Circulation

858

804

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espite recent data suggesting that the rate of increase of obesity among children and adolescents has slowed and overall prevalence has possibly begun to plateau, 1,2 a worrisome trend has emerged in the form of severe pediatric obesity. As the fastest-growing subcategory of obesity in children and adolescents, 1,3,4 severe obesity afflicts between 4% and 6% of all youth in the United States 3-7 and has both immediate and long-term health consequences. Recent data further Abstract-Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing.Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behaviorbased treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks. (Circulation. 2013;128:1689-1712.)

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“…Também na adolescência, a obesidade tornou-se uma doença comum, sendo que 4,1 milhões de adolescentes americanos têm índice de massa corporal (IMC) acima do percentil 95 (1).…”

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Beribéri pós bypass gástrico: uma complicação não tão rara. Relato de dois casos e revisão da literatura

Alves

Gonçalves

Cordeiro

et al. 2006

Arq Bras Endocrinol Metab

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RESUMOÉ crescente o número de pacientes submetidos à cirurgia bariátrica para tratamento da obesidade mórbida; devido a isso, estão reaparecendo deficiências nutricionais com as quais muitos médicos já não estão familiarizados. No pós-operatório, podem ocorrer vários distúrbios nutricionais, sendo um deles a deficiência de tiamina (beribéri). A deficiência de tiamina e/ou vitamina B12 pode corresponder a 40% dos casos de neuropatia após a cirurgia bariátrica. Serão descritos dois pacientes com a clínica de neuropatia periférica e síndrome de Wernicke-Korsakoff. Alguns meses após a cirurgia, eles apresentaram prostração, depressão, confusão mental e nistagmo, associados a dor e parestesia dos membros (principalmente inferiores). Com a hipótese diagnóstica de beribéri, foi iniciado o tratamento com tiamina. Um dos pacientes apresentou melhora completa do quadro neurológico, porém o outro permaneceu com déficit motor, sendo aquele em que decorreu o maior tempo entre o aparecimento dos sintomas e o início do tratamento. Estes casos servem para nos alertar sobre a importância da vigilância nutricional após a cirurgia bariátrica. The number of patients submitted to bariatric surgery to treat morbid obesity is increasing, therefore, some nutritional deficiencies, with which many physicians are no longer familiarized, are reappearing. Postoperatively, many nutritional disorders may occur, one of them is thiamine deficiency (beriberi). The thiamine and/or vitamin B12 deficiency can correspond to 40% of the neuropathy cases after bariatric surgery. Two patients with the clinic of peripheral neuropathy and Wernicke-Korsakoff syndrome will be reported. Some months after the surgery, they presented prostration, depression, mental confusion and nystagmus, associated with pain and paresthesia in limbs (especially lower limbs). With the diagnostic hypothesis of beriberi, the treatment with thiamine started. One of the patients presented complete improvement of the neurological symptoms, however the other one remained with motor deficiency, exactly the one who spent a longer period of time between the symptoms appearance and the treatment beginning. These cases serve to alert us about the importance of nutritional vigilance after bariatric surgery. (Arq Bras Endocrinol Metab 2006;50/3:564-568)

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Long-term follow-up and the role of surgery in adolescents with morbid obesity

Cited by 45 publications

References 29 publications

Should bariatric surgery be performed in adolescents?

Should bariatric surgery be performed in adolescents?

Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches

Beribéri pós bypass gástrico: uma complicação não tão rara. Relato de dois casos e revisão da literatura

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