Metabolic and hormonal changes after laparoscopic sleeve gastrectomy in pediatric population: An observational study

Abstract

IntroductionDespite the growing popularity of laparoscopic sleeve gastrectomy (SG) for managing severe obesity in children, adolescents, and adults, there is a paucity of studies reporting the effects of SG on metabolic and hormonal outcomes in pediatric populations.MethodologyIn this single-centre, retrospective study, we assessed nutritional biomarkers (hemoglobin, ferritin, iron profile, Vitamin B12, Vitamin D, and calcium), glucose homeostasis indicators (C-peptide, HbA1C, and random blood glucose), blood lipids (triglycerides and cholesterol components), hormones involved in the hypothalamic-pituitary-adrenal axis (cortisol and adrenocorticotropic hormone), and thyroid hormones (T3, T4, thyroid-stimulating hormone, and parathyroid hormone) preoperatively and 12-month after SG in children aged 5–15 years.ResultsThis study included 64 adolescents (mean age = 11.2 ± 2.3 years) who underwent laparoscopic SG. Significant reduction in circulatory C-peptide (−62.1%; p = 0.005), HbA1C (−10.9%; p = 0.001), random blood glucose (−15.4%; p = 0.036), and triglycerides (−39.4%; p = 0.003) were observed postoperatively at 12 months compared to baseline. Although we did not observe any changes in cortisol levels, adrenocorticotropic hormone levels declined significantly by −40.9% postoperatively (p = 0.033). However, cholesterol components, thyroid hormones, and nutritional biomarkers remained unchanged from baseline.ConclusionsConsistent with prior literature, our study demonstrates improvement or resolution of diabetes and hypertriglyceridemia in the year following SG. However, given that blood cholesterol components, nutritional biomarkers, and thyroid profiles remained unchanged warrants long-term monitoring of nutritional, metabolic, and endocrine factors in adolescents undergoing laparoscopic SG. To the best of our knowledge, this is the first study reporting the effects of SG on thyroid and hypothalamic-pituitary-adrenal axis hormones in pediatric populations.

Commentary: Metabolic and hormonal changes after laparoscopic sleeve gastrectomy in pediatric population: an observational study

“…We read with great interest the paper by Alghamdi and colleagues ( 1 ) that studied nutritional biomarkers, glucose homeostasis indicators, blood lipids, hormones involved in the hypothalamic-pituitary-adrenal axis, and thyroid hormones before laparoscopic sleeve gastrectomy (LSGE) for managing severe obesity in children aged 5–14 years and repeated analysis 12 months after surgery. In comparison to baseline values, a significant reduction in circulatory C-peptide, hemoglobin, random blood glucose, and triglyceride concentrations was shown in postoperative observation ( 1 ). Subsequently, the authors concluded that 12 months following LSGE, there were improvements or the resolution of diabetes and hypertriglyceridemia among these children.…”

“…Subsequently, the authors concluded that 12 months following LSGE, there were improvements or the resolution of diabetes and hypertriglyceridemia among these children. However, blood cholesterol components, nutritional biomarkers, cortisol value, and thyroid profiles remained unchanged ( 1 ).…”

“…In these circumstances, if the authors include the laboratory references of normal-weight children and adolescents for males and females, there will be an explanation for HMPs’ changes related to surgery or the growing children. Another point for the question is that the authors ( 1 ) did not include preoperative and postoperative weight, height, and body mass index (BMI) parameters or dietary changes. However, they mentioned about in the discussion section.…”

“…It is well known that there are early and late complications of LSGE. However, the authors ( 1 ) did not describe the surgical technique in children and adolescents or its possible complications.…”

“…In this study ( 1 ), the authors aimed to evaluate HMPs’ changes in the pediatric population, but the aspects of this issue that we highlighted needed to be considered. The authors should not apply standards of this surgical treatment for adults to the pediatric population with a broad range of ages 5–14 years, including children and adolescents, as well as boys and girls in one group ( 1 ).…”