Preoperative considerations for the pediatric patient undergoing metabolic and bariatric surgery

Pratt, Janey; Roque, Sebastian; Valera, Ruben; Czepiel, Kathryn S.; Tsao, Deborah D.; Stanford, Fatima Cody

doi:10.1016/j.sempedsurg.2020.150890

Cited by 14 publications

(14 citation statements)

References 93 publications

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“…Thus, it seems highly advisable for pediatric surgeons to join a high-volume center for adult bariatric surgery. In the US, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) requires for adolescent bariatric surgery that a children’s hospital conducting fewer than 25 stapling cases per year invites an MBSAQIP-verified bariatric surgeon on each case [ 14 ].…”

Section: Surgical Principles and Methodsmentioning

confidence: 99%

“…The American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee has recently updated their guidelines [ 3 ]. Adolescents with class II obesity and a diagnosed co-morbidity or with class III obesity should be considered for MBS [ 14 ].…”

Section: Indication For Metabolic Bariatric Surgery In Adolescentsmentioning

confidence: 99%

“…Pratt et al recently recommended treatment teams to conduct a thorough pre-operative evaluation including metabolic profiling but also to provide sufficient education about the surgical interventions and the postoperative lifestyle changes that will be necessary [ 14 ].…”

Section: Indication For Metabolic Bariatric Surgery In Adolescentsmentioning

confidence: 99%

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Update on Metabolic Bariatric Surgery for Morbidly Obese Adolescents

et al. 2021

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Despite worldwide public attention and intense medical efforts, the prevalence of severe morbid obesity in children and adolescents is still rising. Similar to adults, excess adipose tissue triggers multiple immunological and metabolic pathways leading to serious co-morbidities such as impaired glucose tolerance or even type 2 diabetes (T2D), dyslipidemia, arterial hypertension, non-alcoholic fatty liver disease, and hyperuricemia. The management of severe childhood obesity requires a life-long multidisciplinary approach with a combination of lifestyle changes, nutrition, and medications. Standardized life-style intervention programs remain the first-line treatment for morbid obese children and adolescents, but unfortunately reveal limited long-term success. In such cases, metabolic bariatric surgery (MBS) has evolved from being a controversial issue to being included in distinct recommendations. According to the American Society for Metabolic and Bariatric Surgery (ASMBS) Pediatric Committee, indications for bariatric surgery in adolescence must follow very strict criteria. Adolescents with class II obesity (BMI > 120% of the 95th percentile) and a diagnosed co-morbidity or with class III obesity (BMI ≥ 140% of the 95th percentile) should be considered for MBS. These interventions represent high-risk operations, and adolescents should be treated in specialized, multidisciplinary high-volume obesity centers with long-term follow-up programs. The Roux-en-Y gastric bypass (RYGB) remains the gold standard of all malabsorptive procedures. Laparoscopic sleeve gastrectomy (LSG), which the authors pioneered as a stand-alone procedure in morbidly obese adolescents in 2008, has become the most commonly performed operation in morbidly obese adolescents at present. Recent literature proves that MBS is safe and effective in morbidly obese adolescents. Mid-term data have revealed significant improvement or even resolution of major co-morbidities. Thus, MBS for the treatment of morbidly obese adolescents has evolved from being a controversial issue to being included in distinct recommendations by several medical societies as a therapeutic strategy to reduce severe co-morbidities potentially causing end-organ damage in adulthood.

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Section: Surgical Principles and Methodsmentioning

confidence: 99%

Section: Indication For Metabolic Bariatric Surgery In Adolescentsmentioning

confidence: 99%

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Update on Metabolic Bariatric Surgery for Morbidly Obese Adolescents

et al. 2021

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“…According to a meta-analysis, Roux Y gastric bypass (RYGB), sleeve gastrectomy, and biliopancreatic diversion are efficient bariatric procedures in HOb with childhood-onset CP, but still larger studies are needed [97]. The contraindications for bariatric surgery in CP patients are similar to those in other patients with obesity and include substance abuse and psychological disorders.…”

Section: Hypothalamic Dysfunction In Postoperative Cp Patientsmentioning

confidence: 99%

Postoperative and Long-Term Endocrinologic Complications of Craniopharyngioma

Bereket¹

2020

Horm Res Paediatr

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Background: Craniopharyngioma (CP), despite being a malformational tumor of low histological grade, causes considerable morbidity and mortality mostly due to hypothalamo-pituitary dysfunction that is created by tumor itself or its treatment. Summary: Fluid-electrolyte disturbances which range from dehydration to fluid overload and from hypernatremia to hyponatremia are frequently encountered during the acute postoperative period and should be carefully managed to avoid permanent neurological sequelae. Hypopituitarism, increased cardiovascular risk, hypothalamic damage, hypothalamic obesity, visual and neurological deficits, and impaired bone health and cognitive function are the morbidities affecting the well-being of these patients in the long term. Key Messages: Timely and optimal treatment of early postoperative and long-term complications of CP is crucial for preserving quality of life of these patients.

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“…MBS is currently the most effective means of weight loss, which occurs because of multiple mechanisms, including decreased caloric intake and alterations in hormonal, neural, and nutrient pathways [ 13 ]. The use of MBS at younger ages is increasing due to the increased prevalence of severe obesity in adolescence and because of the paucity of other effective weight loss strategies in this age group [ 14 ]. Sleeve gastrectomy (SG) is the most commonly employed MBS in adolescents [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

One-Year Self-Reported Appetite Is Similar in Adolescents with Obesity Who Do or Do Not Undergo Sleeve Gastrectomy

et al. 2022

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Background: With the growing prevalence of severe obesity in adolescents, sleeve gastrectomy (SG), a type of metabolic bariatric surgery (MBS), is increasingly being performed at a younger age. Data regarding changes in homeostatic and hedonic appetite following SG are conflicting in adults, with some studies showing no change and others showing a decrease in appetite. Data evaluating the effect of SG on appetite during adolescence, when appetite is more plastic, are currently lacking. Objective: To evaluate appetite changes one year after SG in adolescents with obesity vs. in non-surgical controls (NS). Methods: Thirty-nine subjects 13–21 years old with severe obesity were followed for a year; 19 underwent SG, and 20 were followed without surgery. Subjects had fasting blood tests for appetite-regulating hormones and completed a visual analog scale for appetite assessment (VAS). Results: The SG group had a decrease in body mass index (BMI) at one-year (baseline: 48.2 ± 1.7 kg/m2; one-year follow-up: 42.6 ± 1.0 kg/m2 (p ≤ 0.0001)). No within- or between-group differences were noted in the one-year change in appetite in the SG and NS groups. After SG, fasting ghrelin decreased (p ≤ 0.0001); however, no changes were noted in peptide YY (PYY) levels. Changes in one homeostatic appetite measure following SG were inversely associated with changes in fasting PYY (r = −0.583, p = 0.011). Appetite changes were not associated with weight loss or final BMI. Conclusions: There were no changes in appetite measures one-year after SG from pre-surgery levels in adolescents with obesity, and appetite changes were not associated with changes in BMI. It is important to evaluate the impact of long-term appetite changes, if any, on weight loss after SG.

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Preoperative considerations for the pediatric patient undergoing metabolic and bariatric surgery

Cited by 14 publications

References 93 publications

Update on Metabolic Bariatric Surgery for Morbidly Obese Adolescents

Update on Metabolic Bariatric Surgery for Morbidly Obese Adolescents

Postoperative and Long-Term Endocrinologic Complications of Craniopharyngioma

One-Year Self-Reported Appetite Is Similar in Adolescents with Obesity Who Do or Do Not Undergo Sleeve Gastrectomy

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