Long-Term Outcome of Bariatric Surgery in Morbidly Obese Adolescents: a Systematic Review and Meta-Analysis of 950 Patients with a Minimum of 3 years Follow-Up

Shoar, Saeed; Mahmoudzadeh, H; Naderan, Mohammad; Bagheri-Hariri, Shahram; Wong, Catherine; Parizi, Ahmad Shahabeddin; Shoar, Nasrin

doi:10.1007/s11695-017-2738-y

Cited by 86 publications

(46 citation statements)

References 35 publications

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“…40 In nonsyndromic paediatric populations, recent systematic reviews showed that significant and durable weight loss results could be achieved for up to 7 years. 10 Comparing with the other literature data that reported the 5-year outcomes of bariatric surgery on PWS patients, the weight loss outcomes of our patient cohort were slightly more inferior (Table 4).…”

Section: Revisional Surgerysupporting

confidence: 39%

“…8,9 To treat nonsyndromic childhood and adolescent obesity, bariatric surgery has been increasingly advocated due to its favourable weight loss outcomes similar to adults. 10 As for PWS, while the contemporary bariatric operations are regarded as safe procedures, the efficacy of bariatric surgery on weight loss and comorbidity resolution was largely inconsistent. Long-term follow-up data were particularly lacking.…”

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confidence: 99%

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Bariatric surgery for Prader‐Willi syndrome was ineffective in producing sustainable weight loss: Long term results for up to 10 years

et al. 2019

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Summary Background Obesity control in Prader‐Willi syndrome (PWS) is notoriously difficult. The role of bariatric surgery in PWS remains controversial as long‐term data are lacking. Objectives To evaluate the 10‐year outcomes of bariatric surgery in PWS. Methods This was a prospective observational study on PWS patients who received bariatric surgery and multidisciplinary follow‐up programmes for obesity control. Outcomes on weight reduction and comorbidity resolution were evaluated. Results Between 2008 and 2013, five PWS patients (two males, mean age 19.2 ± 3.0 years) with body mass index of 47.3 ± 6.9 kg m−2 received sleeve gastrectomy (n = 2), one anastomosis gastric bypass (n = 2), and Roux‐en‐Y gastric bypass (n = 1) after failing all non‐operative weight loss programmes. The median follow‐up was 8.4 ± 2.2 years. The best mean percentage of total weight loss (%TWL) was achieved at 2 years (24.7%). %TWL dropped to 23.3% at 3 years, 11.9% at 5 years, 4.1% at 8 years, and 0% at 10 years. Each patient had at least three comorbidities preoperatively, but none of them had resolution of any one of the comorbidities at the last follow‐up. Conclusions Bariatric surgery could not produce sustainable long‐term weight loss or comorbidity resolution in PWS. This study suggests that bariatric surgery cannot be recommended to PWS patients as a standard treatment.

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Section: Revisional Surgerysupporting

confidence: 39%

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confidence: 99%

Bariatric surgery for Prader‐Willi syndrome was ineffective in producing sustainable weight loss: Long term results for up to 10 years

et al. 2019

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“…At 36 months, significant weight loss was maintained with a mean BMI reduction of 10.3% in patients who underwent LAGB, 13% in patients who underwent VSG, and 15% in patients who underwent RYGB. 26,27 More recently, an analysis of electronic health record data compared the effectiveness of bariatric procedures among pediatric patients and demonstrated a similar BMI reduction among patients who received VSG or RYGB, and a lower BMI reduction in patients who received LAGB. 28 Complications Surgical complications are infrequent, with the majority being defined as minor (15%) and occurring in the early postoperative period (eg, postoperative nausea and dehydration).…”

Section: Outcomes On Weight Loss and Comorbidity Resolutionmentioning

confidence: 99%

“…28 Complications Surgical complications are infrequent, with the majority being defined as minor (15%) and occurring in the early postoperative period (eg, postoperative nausea and dehydration). 11,16,27 Major perioperative complications (30 days) were reported in 8% of Teen-LABS participants. In addition, 2.7% required reoperation before hospital discharge, which was similar to adults.…”

Section: Outcomes On Weight Loss and Comorbidity Resolutionmentioning

confidence: 99%

Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices

et al. 2019

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Severe obesity among youth is an "epidemic within an epidemic" and portends a shortened life expectancy for today' s children compared with those of their parents' generation. Severe obesity has outpaced less severe forms of childhood obesity in prevalence, and it disproportionately affects adolescents. Emerging evidence has linked severe obesity to the development and progression of multiple comorbid states, including increased cardiometabolic risk resulting in end-organ damage in adulthood. Lifestyle modification treatment has achieved moderate short-term success among young children and those with less severe forms of obesity, but no studies to date demonstrate significant and durable weight loss among youth with severe obesity. Metabolic and bariatric surgery has emerged as an important treatment for adults with severe obesity and, more recently, has been shown to be a safe and effective strategy for groups of youth with severe obesity. However, current data suggest that youth with severe obesity may not have adequate access to metabolic and bariatric surgery, especially among underserved populations. This report outlines the current evidence regarding adolescent bariatric surgery, provides recommendations for practitioners and policy makers, and serves as a companion to an accompanying technical report, "Metabolic and Bariatric Surgery for Pediatric Patients With Severe Obesity," which provides details and supporting evidence. This policy statement uses the term "pediatric" in reference to a person under 18 years of age. The term "adolescent" may be defined differently in various studies and clinical settings on the basis of age or developmental stage. When making specific recommendations, this policy statement uses "adolescent" to refer to a person from age 13 years to age 18 years. "Severe" obesity (class 2 obesity or higher) is defined as having a BMI $35

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“…The guidelines call for frequent and comprehensive labs that can equate to significant costs. While bariatric surgical procedures are able to effectively reduce the amount of caloric consumption through anatomic and physiologic alteration, nutritional deficiency can be an additional unintended result [1,2]. To remedy the latter, patients are prescribed nutritional supplements and undergo a series of follow-up blood tests following bariatric surgery to detect potential nutritional deficiencies.…”

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confidence: 99%

Post-bariatric surgery lab tests: are they excessive and redundant?

et al. 2019

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Introduction Following bariatric surgery, ongoing postoperative testing is required to measure nutritional deficiencies; the purpose of this study was to quantify the prevalence of these nutritional deficiencies based on two-year follow-up tests at recommended time points. Methods and procedures A retrospective data analysis was conducted of all laboratory tests for bariatric patients who underwent surgery between May 2016 and January 2018 with available lab data (n = 397). Results for nine different nutritional labs were categorized into six recommended postoperative time periods based on time elapsed since the procedure date. Binary variables were created for each laboratory result to calculate descriptive statistics of abnormalities for each lab test over time and used in the individual GEE logistic regression models. Grouped logistic regression examined the total nutritional deficiencies of the nine combined nutrients considering total available labs. Results Multiple lab tests indicated a very low frequency of abnormalities (e.g., Vitamin A, Vitamin B12, Copper, and Folate). Many of the nine included nutritional labs had an average deficiency of less than 10% across all time points. The grouped logistic model found preoperative nutritional deficiency to be predictive of postoperative nutritional deficiency (OR 3.70, p < 0.001). Conclusions We found the vast majority of routine lab test results to be normal at multiple time points. Current practice can add up to significant lab expenses over time. The frequency of postoperative testing in this population may be redundant and of very little value. Unnecessary follow-up laboratory testing costs the patients and the health care system in both time and resources. Patients with preoperative deficiencies appear to be at higher risk for nutritional deficiencies when compared to bariatric surgery patients that did not have preoperative nutritional deficiencies. Future research should focus on defining cost effective postoperative lab testing guidelines for at risk bariatric patients.

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Long-Term Outcome of Bariatric Surgery in Morbidly Obese Adolescents: a Systematic Review and Meta-Analysis of 950 Patients with a Minimum of 3 years Follow-Up

Abstract: Although bariatric surgery is a safe and effective procedure in the treatment of adolescent morbid obesity, long-term data is scarce regarding its nutritional and developmental complication in this growing population of patients.

Cited by 86 publications

References 35 publications

Bariatric surgery for Prader‐Willi syndrome was ineffective in producing sustainable weight loss: Long term results for up to 10 years

Bariatric surgery for Prader‐Willi syndrome was ineffective in producing sustainable weight loss: Long term results for up to 10 years

Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices

Post-bariatric surgery lab tests: are they excessive and redundant?

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