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Hope for Obese Adolescents

Adjustable gastric banding is a safe and effective alternative to gastric bypass.

Bariatric surgery has been used in pediatric patients after medical management of obesity has failed. The gastric bypass procedure is traditionally performed, but it carries risks for mortality and morbidity. Investigators at one institution in New York City report 1-year outcomes of 53 morbidly obese adolescents (age range, 13–17 years; mean weight, 297 pounds; 77% female; 81% white) who underwent laparoscopic adjustable gastric banding (LAGB).

During post-surgical follow-up visits, gastric bands were adjusted based on appetite, weight loss, food restriction, and satiety. No intraoperative complications were reported; 9.4% of patients had minor operative complications. The mean percentage of excess weight loss was 37.5% at 6 months and 62.7% at 1 year. Mean preoperative weight decreased from 297 pounds to 242 pounds at 6 months (33 patients) and to 204 pounds at 12 months (18 patients); mean BMI decreased from 47.6 kg/m² to 39.5 kg/m² at 6 months and to 32.3 kg/m² at 12 months.

Comment: The authors conclude that LAGB is a safe and effective treatment for morbidly obese adolescents. LAGB appears to be a reasonable surgical approach for those who cannot be managed medically because it is less invasive than gastric bypass, with an average operative time of 38 minutes and discharge within 24 hours. The authors also note that the number and severity of complications in their study are less than those reported in obese adolescents who have undergone gastric bypass. Although patients need to be observed for nutritional deficiencies and mechanical problems after gastric banding, 1-year outcomes are impressive. Obviously, prevention of obesity is still the best approach.

— William P. Kanto, Jr., MD

Published in Journal Watch Pediatrics and Adolescent Medicine March 14, 2007

Citation(s):

Nadler EP et al. Short-term results in 53 US obese pediatric patients treated with laparoscopic adjustable gastric banding. J Pediatr Surg 2007 Jan; 42:137-41.

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