Bariatric Surgery Safe in Very Obese Teens - Study

Teenagers -- some even with lots of comorbidities fare well after weight loss surgery.  

Medpage - via JAMA

Severely obese teens who underwent weight-loss surgery had a low number of short-term complications following treatment, researchers found.

Among a sample of teens who received gastric bypass, vertical sleeve gastrectomy, or adjustable gastric banding, there were no deaths during the initial hospitalization or within 30 days of any operation, according to Thomas Inge, MD, PhD, of Cincinnati Children's Hospital Medical Center, and colleagues.

Medpage -

Major complications, such as reoperation, occurred in 8% and minor complications, including readmission for dehydration, happened in 15%. However, all major and the majority of minor (85%) complications were related to the patient's surgery, they wrote online in JAMA Pediatrics.

"The fact that major, life-threatening complications were infrequently observed documents the short-term safety of these procedures in this patient population," the group concluded.

Past research has found gastric banding has similar efficacy and resolution of comorbidity in adolescents as in adults and fewer complications than in adult patients.

The authors also noted that "nonsurgical weight-loss interventions rarely result in a substantial and sustained reduction in body mass index [BMI] or resolution of comorbidities for those who are severely obese."

They studied the preoperative characteristics and perioperative safety outcomes of 242 teenage patients who were severely obese and underwent weight loss surgery.

Participants were enrolled in the Teen-LABS (Teen-Longitudinal Assessment of Bariatric Surgery) study, which was designed to collect standardized prospective pre-operative and post-operative clinical, as well as laboratory data on teens receiving weight loss surgery.

Researchers gathered data on presence or absence of comorbidities within 30 days before the procedure through medical records, physical examination, patient interview, and laboratory tests.

Major perioperative complications included life-threatening events, events that had the potential for permanent harm, complications resulting in organ loss, those that required reoperation or blood transfusion, or that were associated with a major change in anesthetic or operative management.

Minor complications were those that involved unplanned perioperative events, additional testing, specific medical management, non-oral enteral feedings at discharge, or use of any parenteral nutrition at discharge.

Participants were followed-up with from discharge to 30 days after the procedure for major complications, which included reoperation, and minor complications, including events that required outpatient percutaneous or endoscopic intervention and readmission for inpatient management.

At baseline, mean patient age was 17.1 years, median BMI was 50.5 kg/m², and median waist circumference was 145.9 cm. BMI greater than 60 kg/m² was common to 21% of the sample.

Roughly half of the cohort had three or fewer comorbid conditions (49%), 39% had four or five, and 12% had six or more. Common comorbidities included dyslipidemia (74%), sleep apnea (57%), back and joint pain (46%), hypertension (45%), and fatty liver disease (37%).

Most patients had elevated C-reactive protein (75%), hyperinsulinemia (71%), and low high-density lipoprotein (64%), and 40% had hypertriglyceridemia.

Two-thirds of the participants underwent Roux-en-Y gastric bypass (66%), while 28% received vertical sleeve gastrectomy, and 6% received an adjustable gastric band.

By procedure, major complications were common to 9.3% of gastric bypass patients, 4.5% of gastrectomy patients, and 7.1% of banded patients. Minor events occurred in 16.8% of bypass patients, 11.9% of gastrectomy patients, and 7.1% of banded patients.

"Most of the major and minor complications occurred prior to discharge," they noted.

After discharge, 2.9% experienced major complications such as pulmonary embolus, gastrointestinal leak, and a leak that required drain and stent. Minor complications, such as dehydration and abdominal/gastrointestinal complaints and requiring upper endoscopy, occurred in 11.2%.

Editorialist Michael Sarr, MD, of the Mayo Clinic in Rochester, Minn., noted that the current results reflect important findings in a problem that, in adolescents, extends well beyond long-term physical health into psychological health. "Severely obese teens have a three- to fourfold greater prevalence of depression, as well as substantive impairments in global functioning across the domains of physical, social, emotional, and school work," he wrote.

He also noted that "as parents ourselves, we have come to more openly acknowledge the peer victimization that occurs all too often in these unfortunate children."

The authors noted that their study was limited by a lack of generalizability and lack of standardization in surgical technique and clinical care.